Efficacy of Different Doses of Clopidogrel in Combination with Aspirin in Patients with HR-NICE by Point-of-care Testing of CYP2C19 Gene
10.11969/j.issn.1673-548X.2023.11.024
- VernacularTitle:不同剂量氯吡格雷联合阿司匹林在CYP2C19基因即时检测下对HR-NICE患者的疗效研究
- Author:
Xiaoru ZHU
1
,
2
;
Guofang CHEN
;
Guanzhi SHI
Author Information
1. 223000 徐州医科大学附属淮安医院/淮安市第二人民医院
2. 221009 徐州医科大学徐州临床学院神经内科
- Keywords:
CYP2C19;
Point-of-care testing;
Clopidogrel;
High risk non-disabling ischemic stroke
- From:
Journal of Medical Research
2023;52(11):123-127,208
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy of different doses of clopidogrel combined with aspirin in the treatment of high-risk non-disabling ischaemic cerebrovascular events(HR-NICE)under the precise guidance of point-of-care testing(POCT)of cy-tochrome P-450 2C19(CYP2C19)genotype.Methods The single-center,randomised,prospective,and blinded endpoint assess-ment was used.HR-NICE patients continuously enrolled in the stroke green channel and neurology ward of Xuzhou Central Hospital from January 2021 to January 2022,and all patients scraping of the buccal mucosa will be screened for CYP2C19 loss-of-function allele car-riers by POCT.According to the random number table method,they were divided into the intensive group(clopidogrel 150mg/d)and the conventional group(clopidogrel 75mg/d)combined with aspirin(100mg/d)dual antiplatelet for 21 days.Baseline information,acute stroke Org 10172 treatment trial(TOAST)staging and 90 days modified Rankin scale(mRS)score and occurrence of adverse events and severe adverse events were collected for the two groups.The primary efficacy outcome was new stroke within 90 days and the primary safety outcome was severe or moderate bleeding within 90 days.Results A total of 1301 patients were screened,of which 727 patients carried CYP2C19 loss-of-function allele,and 476 patients were included:236 patients in the intensive group and 240 patients in the conven-tional group.The differences between the two groups were not statistically significant at baseline(P>0.05);4 cases(1.7%)inthein-tensive group and 26 cases(10.8%)in the conventional group had a new stroke at 90 days.The differences between the two groups were statistically significant(χ2 = 16.827,P<0.001);0 case(0)in the intensive group and1 case(2.5%)in the conventional group had moderate to severe haemorrhage at 90 days.The differences between the two groups was not statistically significant(P>0.05).Conclu-sion In HR-NICE patients with CYP2C19 loss-of-function allele,the enhanced clopidogrel dose was more effective than the conven-tional dose in the treatment with the antiplatelet drug aspirin combined with clopidogrel,and had a consistent safety profile with no more adverse events such as bleeding.
