Impact of Glycemic Control on Efficacy of Clopidogrel in Transient Ischemic Attack or Minor Stroke Patients With CYP2C19 Genetic Variants [Clinical Sciences]

Background and Purpose—Dysglycemia may influence the predictive value of CYP2C19 loss-of-function allele for clinical efficacy of antiplatelet drug, but the role of glycated albumin (GA) remains unclear in patients with stroke on antiplatelet drugs.Methods—The CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) included 2933 patients who had GA levels and CYP2C19 genotyping. Cox proportional hazards model was used to assess the interaction between CYP2C19 loss-of-function allele (*2, *3) carrier status and the effect of antiplatelet therapy based on their GA levels.Results—There was significant interaction between carrier status and antiplatelet therapy regimen on the risk of recurrent stroke (P=0.03) in patients with GA levels of ≤15.5%, but not in those with GA levels of >15.5% (P=0.48). Only in noncarriers with low GA levels, dual-antiplatelet therapy reduced stroke recurrence (3.5%) compared with those on aspirin alone (14.7%; hazard ratio, 0.23; 95% confidence interval, 0.10–0.49; P

Source: Stroke - March 27, 2017 Category: Neurology Authors: Yi Lin, Anxin Wang, Jiejie Li, Jinxi Lin, David Wang, Xia Meng, Lixian Ou, Weiqi Chen, Xingquan Zhao, Liping Liu, Yilong Wang, Yongjun Wang Tags: Biomarkers, Secondary Prevention, Genetics, Ischemic Stroke, Transient Ischemic Attack (TIA) Original Contributions Source Type: research