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Effects of Triflusal and Clopidogrel on the Secondary Prevention of Stroke Based on Cytochrome P450 2C19 Genotyping

Authors
 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 Bushnell  ;  Kyung-Yul Lee 
Citation
 Journal of Stroke, Vol.19(3) : 356-364, 2017 
Journal Title
 Journal of Stroke 
ISSN
 2287-6391 
Issue Date
2017
Keywords
Clopidogrel ; Cytochrome P-450 CYP2C19 ; Stroke ; Triflusal
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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/160916
DOI
10.5853/jos.2017.01249
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실)
Yonsei Authors
김윤남(Kim, Youn Nam)
남효석(Nam, Hyo Suk)
이경아(Lee, Kyung A)
이경열(Lee, Kyung Yul)
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