Ticagrelor reduced the 12-month risk of major adverse cardiovascular events by 68% compared to clopidogrel in CYP2C19 poor metabolizers (HR 0.32, 95% CI 0.11–0.89, P=0.029).
Cohort (n=514)
No
Does CYP2C19 genotype-guided escalation to ticagrelor reduce recurrent ischemic events compared to clopidogrel in patients requiring secondary stroke prevention?
CYP2C19 genotype-guided antiplatelet therapy optimizes secondary stroke prevention by identifying intermediate and poor metabolizers who benefit from switching from clopidogrel to ticagrelor.
Effect estimate: HR 0.32 (95% CI 0.11–0.89)
Absolute Event Rate: 10% vs 30%
p-value: p=0.029
Antiplatelet therapy guided by CYP2C19 genotyping is an effective strategy for optimizing the secondary prevention of ischemic stroke. For IM and PM patients, switching from clopidogrel to ticagrelor significantly reduces the risk of recurrent ischemic events without increasing bleeding risk. In contrast, for EM patients, clopidogrel remained an effective and safe option.
Haidong et al. (2026) conducted a cohort in Adults aged 18-65 years with mild ischemic stroke (NIHSS ≤5) within 72 hours of onset, naïve to or off antiplatelet therapy for ≥1 week, undergoing secondary prevention of ischemic stroke guided by CYP2C19 genotype (n=514). Ticagrelor vs. Clopidogrel 75 mg daily was evaluated on Incidence of major adverse cardiovascular events (MACE) within 12 months including ischemic stroke recurrence, myocardial infarction, and cardiovascular death (HR 0.32, 95% CI 0.11–0.89, p=0.029). Ticagrelor reduced the 12-month risk of major adverse cardiovascular events by 68% compared to clopidogrel in CYP2C19 poor metabolizers (HR 0.32, 95% CI 0.11–0.89, P=0.029).