Effect of antithrombotic therapy selection on stroke recurrence based on drug gene polymorphism and thromboelastography
10.12092/j.issn.1009-2501.2024.09.009
- VernacularTitle:基于药物基因多态性及血栓弹力图选择抗栓治疗对缺血性脑卒中复发的影响
- Author:
Qiuying SONG
1
,
2
;
Chenjuan TAO
;
Zhihao WU
;
Zhefeng XIE
;
Haijun LIU
;
Binbin CHEN
Author Information
1. 杭州师范大学附属医院神经内科,杭州 310015,浙江
2. 德清第三人民医院神经内科,德清 313200,浙江
- Keywords:
aspirin;
clopidogrel;
genetic polymor-phism;
ischemic stroke;
secondary prevention
- From:
Chinese Journal of Clinical Pharmacology and Therapeutics
2024;29(9):1035-1041
- CountryChina
- Language:Chinese
-
Abstract:
AIM:Clopidogrel and aspirin are com-monly used drugs for the secondary prevention of cerebrovascular disease.Due to drug resistance,their preventive effect is often affected.This article explores the clinical value of clopidogrel and aspirin pharmacogenetic genetic testing in the secondary prevention of ischemic stroke.METHODS:220 pa-tients with mild ischemic stroke or TIA admitted to our hospital from 2021.7 to 2022.9 were included and randomly divided into individualized treatment group and clopidogrel conventional treatment group(control group).The patients were followed up for one year to observe stroke recurrence and hemorrhagic events.RESULTS:(1)Compared with the control group,the recurrence rate of ischemic stroke in the individualized treatment group after 1-year follow-up was slightly lower(5.82％vs.7.92％,P＞0.05),the risk of cerebral hemorrhage was simi-lar,but the risk of other occurrences was increased(6.79％vs.0.99％,P＜0.05).(2)COX regression analy-sis showed that ESRS(HR 2.576,95％CI 1.226-5.413,P=0.013)and history of hypertension(HR 5.517,95％CI 1.624-18.737,P=0.006)were associated with recurrence of ischemic stroke,independent of anti-thrombotic regimen(HR 0.918,95％CI 0.291-2.894,P=0.883).CONCLUSION:Aspirin GPIBA,PTGS1,and ITGB3 gene polymorphisms have limited signifi-cance in guiding antiplatelet medication.Selecting aspirin maintenance therapy for clopidogrel CYP2C19*2*3 allele carriers cannot significantly re-duce the risk of recurrence of minor ischemic stroke and may increase other bleeding risks.COX regression analysis shows that ESRS and history of hypertension are independent risk factors for stroke recurrence.
