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Effects of triflusal and clopidogrel on the secondary prevention of stroke based on cytochrome p450 2c19 genotyping

Title
Effects of triflusal and clopidogrel on the secondary prevention of stroke based on cytochrome p450 2c19 genotyping
Authors
Han S.W.Kim Y.-J.Ahn S.H.Seo W.-K.Yu S.Oh S.-H.Nam H.S.Choi H.-Y.Yoon S.S.Kim S.H.Lee J.Y.Lee J.H.Hwang Y.-H.Lee K.O.Jung Y.H.Lee J.Sohn S.-I.Kim Y.N.Lee K.-A.Bushnell C.D.Lee K.-Y.
Ewha Authors
김용재
SCOPUS Author ID
김용재scopus
Issue Date
2017
Journal Title
Journal of Stroke
ISSN
2287-6391JCR Link
Citation
vol. 19, no. 3, pp. 356 - 364
Keywords
ClopidogrelCytochrome P-450 CYP2C19StrokeTriflusal
Indexed
SCIE; SCOPUS WOS scopus
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. © 2017 Korean Stroke Society.
DOI
10.5853/jos.2017.01249
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의과대학 > 의학과 > Journal papers
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