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

Sang Won Han, Yong Jae Kim, Seong Hwan Ahn, Woo Keun Seo, Sungwook Yu, Seung Hun Oh, Hyo Suk Nam, Hye Yeon Choi, Sung Sang Yoon, Seo Hyun Kim, Jong Yun Lee, Jun Hong Lee, Yang Ha Hwang, Kee Ook Lee, Yo Han Jung, Jun Lee, Sung Il Sohn, Youn Nam Kim, Kyung A. Lee, Cheryl D. BushnellKyung Yul Lee

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2 Citations (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.

Original languageEnglish
Pages (from-to)356-364
Number of pages9
JournalJournal of Stroke
Volume19
Issue number3
DOIs
Publication statusPublished - 2017 Sep

Keywords

  • Clopidogrel
  • Cytochrome P-450 CYP2C19
  • Stroke
  • Triflusal

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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    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., ... Lee, K. Y. (2017). Effects of triflusal and clopidogrel on the secondary prevention of stroke based on cytochrome p450 2c19 genotyping. Journal of Stroke, 19(3), 356-364. https://doi.org/10.5853/jos.2017.01249