J Stroke.
2017 Sep;19(3):356-364. 10.5853/jos.2017.01249.
Effects of Triflusal and Clopidogrel on the Secondary Prevention of Stroke Based on Cytochrome P450 2C19 Genotyping
- Affiliations
-
- 1Department of Neurology, Inje University College of Medicine, Seoul, Korea.
- 2Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea.
- 3Department of Neurology, Chosun University School of Medicine, Gwangju, Korea.
- 4Department of Neurology, Samsung Medical Center, Seoul, Korea.
- 5Department of Neurology, Korea University College of Medicine, Seoul, Korea.
- 6Department of Neurology, CHA University College of Medicine, Bundang, Korea.
- 7Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. kylee@yuhs.ac
- 8Department of Neurology, Kyung Hee University School of Medicine, Seoul, Korea.
- 9Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea.
- 10Department of Neurology, National Medical Center, Seoul, Korea.
- 11Department of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.
- 12Department of Neurology, Kyungpook National University School of Medicine, Daegu, Korea.
- 13Department of Neurology, Konyang University College of Medicine, Daejeon, Korea.
- 14Department of Neurology, Changwon Fatima Hospital, Changwon, Korea.
- 15Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea.
- 16Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.
- 17Clinical Trials Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.
- 18Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
- 19Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA.
- KMID: 2408402
- DOI: http://doi.org/10.5853/jos.2017.01249
Abstract
- BACKGROUND AND PURPOSE
To compare the efficacy and safety of antiplatelet agents for the secondary prevention of ischemic stroke based on cytochrome P450 2C19 (CYP2C19) polymorphisms.
METHODS
This study was a prospective, multicenter, randomized, parallel-group, open-label, blind genotype trial. First time non-cardiogenic ischemic stroke patients were enrolled and screened within 30 days. Participants were randomized to receive either triflusal or clopidogrel for secondary stroke prevention. The primary outcome was the time from randomization to first recurrent ischemic stroke or hemorrhagic stroke.
RESULTS
The required sample size was 1,080 but only 784 (73%) participants were recruited. In patients with a poor CYP2C19 genotype for clopidogrel metabolism (n=484), the risk of recurrent stroke among those who received triflusal treatment was 2.9% per year, which was not significantly different from those who received clopidogrel treatment (2.2% per year; hazard ratio [HR], 1.23; 95% confidence interval [CI], 0.60-2.53). In the clopidogrel treatment group (n=393), 38% had good genotypes and 62% poor genotypes for clopidogrel metabolism. The risk of recurrent stroke in patients with a good CYP2C19 genotype was 1.6% per year, which was not significantly different from those with a poor genotype (2.2% per year; HR, 0.69; 95% CI, 0.26-1.79).
CONCLUSIONS
Whilst there were no significant differences between the treatment groups in the rates of stroke recurrence, major vascular events, or coronary revascularization, the efficacy of antiplatelet agents for the secondary prevention of stroke according to CYP2C19 genotype status remains unclear.
Keyword
MeSH Terms
-
Cytochrome P-450 CYP2C19
Cytochrome P-450 Enzyme System*
Cytochromes*
Genotype
Humans
Metabolism
Platelet Aggregation Inhibitors
Prospective Studies
Random Allocation
Recurrence
Sample Size
Secondary Prevention*
Stroke*
Cytochrome P-450 CYP2C19
Cytochrome P-450 Enzyme System
Cytochromes
Platelet Aggregation Inhibitors
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- CYP2C19 Polymorphisms and Smoking Status Affects Responsiveness to the Platelet P2Y12 Receptor Antagonist Clopidogrel
- Concerns on Drug Interactions between Proton Pump Inhibitors and Clopidogrel: Unsafe Perspective
- The good genotype for clopidogrel metabolism is associated with decreased blood viscosity in clopidogrel-treated ischemic stroke patients
- Cytochrome P450 2C19 Polymorphism is Associated with Reduced Clopidogrel Response in Cerebrovascular Disease
- Selection of an Antidepressant Based on the Genotypes of Cytochrome P450 Enzymes Genes in a Patient with Major Depressive Disorder
