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Effects of triflusal and clopidogrel on the secondary prevention of stroke based on cytochrome P450 2C19 genotyping

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Author(s)
Sang Won HanYong-Jae KimSeong Hwan AhnWoo-Keun SeoSungwook YuSeung-Hun OhHyo Suk NamHye-Yeon ChoiSung Sang YoonSeo Hyun KimJong Yun LeeJun Hong LeeYang-Ha HwangKee Ook LeeYo Han JungJun LeeSung-Il SohnYoun Nam KimKyung-A LeeCheryl D BushnellKyung-Yul Lee
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Journal of Stroke
Issued Date
2017
Volume
19
Issue
3
Keyword
ClopidogrelCytochrome P-450 CYP2C19StrokeTriflusal
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.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine (의과대학)
Citation
Sang Won Han et al. (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. doi: 10.5853/jos.2017.01249
Type
Article
ISSN
2287-6391
DOI
10.5853/jos.2017.01249
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41220
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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