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Efficacy of dual antiplatelet therapy after ischemic stroke according to hsCRP levels and CYP2C19 genotype

  • 0From the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; and Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.
American Heart Journal +

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November 13, 2024

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November 13, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Dual antiplatelet therapy is more effective for stroke prevention in patients with low hsCRP and no CYP2C19 loss-of-function alleles. This combination predicts a better response to dual antiplatelets, reducing stroke recurrence.

Area Of Science

  • Cardiology
  • Neurology
  • Pharmacogenomics

Background

  • High-sensitive C-reactive protein (hsCRP) and CYP2C19 genotypes independently predict ischemic stroke outcomes.
  • The CHANCE trial investigated antiplatelet therapy efficacy in stroke patients.

Purpose Of The Study

  • To evaluate the association between CYP2C19 loss-of-function allele (LoFA) carrier status, hsCRP levels, and the effectiveness of dual vs. single antiplatelet therapy.
  • To determine if hsCRP levels modify the impact of CYP2C19 LoFA status on antiplatelet therapy outcomes.

Main Methods

  • Analysis of 2,801 patients from the CHANCE trial with CYP2C19 genotype and hsCRP data.
  • Cox proportional hazards models assessed interactions between CYP2C19 LoFA carrier status, antiplatelet regimen, and hsCRP levels.
  • Primary outcome was recurrent stroke within 90 days; bleeding events were also monitored.

Main Results

  • 58.8% of patients were CYP2C19 LoFA carriers; 32.9% had elevated hsCRP.
  • A significant interaction between LoFA status and antiplatelet regimen was observed in patients with nonelevated hsCRP (P=.048) for recurrent stroke and vascular events.
  • Dual antiplatelets significantly reduced stroke risk versus aspirin alone in non-LoFA carriers with nonelevated hsCRP (HR=0.44, P=.003); no bleeding differences were noted.

Conclusions

  • Nonelevated hsCRP combined with non-carrier status for CYP2C19 LoFA may identify minor stroke and high-risk TIA patients who benefit most from dual antiplatelet therapy.
  • This genetic and inflammatory profile predicts a superior response to dual antiplatelets in preventing recurrent stroke and vascular events.

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