Platelet Aggregation Inhibitors Clinical Trial
Official title:
The Influence of CYP2C19 Polymorphism on Antiplatelet Effects and Clinical Outcomes in Non-acute Stroke Patients Treated With Clopidogrel: The Contribution of Genetic Analysis to the Efficacy of Clopidogrel (Cognac) Study
Background:
Clopidogrel, an antiplatelet prodrug, is widely used for prevention of the recurrent
cardiovascular events. CYP2C19 is one of the crucial enzymes for the activation of
clopidogrel. Recent studies, mostly done in cardiovascular patients, showed association of
the CYP2C19 genotypes with recurrent cardiovascular events. However, prospective data on the
impact of the genetic variants in stroke patients are limited.
Methods:
Five hundred and eighteen Japanese non-acute stroke patients treated with clopidogrel were
registered at 14 institutions. Three CYP2C19 variants (CYP2C19*2, *3, *17) were genotyped
and the patients were classified into three clopidogrel metabolizer groups inferred from the
CYP2C19 genotypes: extensive (EM: *1/*1), intermediate (IM: *1/*2 or *1/*3), and poor (PM:
*2/*2, *2/*3, or *3/*3). The CYP2C19*17 carriers were excluded from the analysis. The
antiplatelet effects of clopidogrel were assessed by Adenosine diphosphate (ADP) -induced
platelet aggregation and vasodilator-stimulated phosphoprotein (VASP) phosphorylation,
expressed as VASP index. The endpoint was the composite incidence of stroke, transient
ischemic attack, myocardial infarction, revascularization, other thromboembolic disease, or
cardiovascular death during 2 years of follow-up.
n/a
Observational Model: Cohort, Time Perspective: Prospective
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