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Journal of Neurology

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01-10-2018 | Original Communication

Aspirin plus clopidogrel may reduce the risk of early neurologic deterioration in ischemic stroke patients carrying CYP2C19*2 reduced-function alleles

Authors: Xingyang Yi, Qiang Zhou, Chun Wang, Jing Lin, Zhenxiao Chai

Published in: Journal of Neurology | Issue 10/2018

Abstract

Objectives

The mechanisms of early neurologic deterioration (END) and prevention strategies for END are not completely understood. The aim of this study was to investigate the association between CYP2C19*2 variants and END, and the effectiveness of antiplatelet therapy for prevention of END according to CYP2C19*2 genotypes in patients with ischemic stroke (IS).

Materials and methods

This was a two-center, randomized controlled study. Between August 2009 and December 2011, 570 IS patients were randomly assigned to clopidogrel plus aspirin group (n = 284) or aspirin alone group (n = 286). Platelet aggregation and platelet–leukocyte aggregates were measured before and after 7–10 days of treatment. CYP2C19*2 (rs4244285) genotypes were examined using mass spectrometry. The primary outcome was END during the 10 days of admission.

Results

Among the 570 patients, 121 (21.2%) patients suffered from END. Carriers of CYP2C19*2 reduced-function alleles were associated with higher incidence of END (26.8% in carriers vs. 16.6% in noncarriers, P = 0.004). The incidence of END was lower in the clopidogrel plus aspirin group than in the aspirin alone group (17.6 vs. 24.8%, P = 0.032). Stratified analyses revealed that clopidogrel plus aspirin could be more effective in reducing END than aspirin alone for carriers of CYP2C19*2 reduced-function alleles (18.8 vs. 34.9%, P = 0.006). However, there was no significant difference in incidence of END between dual therapy group and monotherapy group for noncarriers (16.7 vs. 16.6%, P = 0.998).

Conclusions

Dual therapy with clopidogrel and aspirin may be adequate for prevention of END in carriers of CYP2C19 reduced-function alleles, but not for noncarriers. Our findings may be useful to guide precise antiplatelet therapy, and decrease the risk of END.

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Title: Aspirin plus clopidogrel may reduce the risk of early neurologic deterioration in ischemic stroke patients carrying CYP2C19*2 reduced-function alleles
Authors: Xingyang Yi
Qiang Zhou
Chun Wang
Jing Lin
Zhenxiao Chai
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 10/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8998-1

At a glance: The STEP trials

Springer Medicine

Aspirin plus clopidogrel may reduce the risk of early neurologic deterioration in ischemic stroke patients carrying CYP2C19*2 reduced-function alleles

Abstract

Objectives

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

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