Antiplatelet effect of ticagrelor with aspirin in acute minor stroke and transient ischemic attack stratified by CYP2C19 metabolizer status: subgroup analysis of the PRINCE trial.

Abstract

Studies on antiplatelet effect of ticagrelor/aspirin and clopidogrel/aspirin in patients with acute minor stroke and transient ischemic attack (TIA) stratified by CYP2C19 metabolizer status is limited. We gained data from the Platelet Reactivity In Non-disabling Cerebrovascular Events study. Platelet reactivity was tested at baseline, 2 hours, 24 hours, 7 days and 90 days after initial dose, including high on-treatment platelet reactivity (HOPR), which was defined as P2Y12 reaction unit >208, and percentage inhibition of platelet aggregation (IPA). A total of 365 patients were included. There were 199 (54.5%) individuals classified as carriers of CYP2C19 loss-of-function alleles. For carriers and non-carriers, the proportions of HOPR were significantly lower in those with ticagrelor/aspirin compared with those with clopidogrel/aspirin at 2 hours, 24 hours, 7 days, respectively (all p<0.05). IPA was higher at all time points except at baseline in patients with ticagrelor/aspirin compared with those with clopidogrel/aspirin in both carriers and non-carriers of CYP2C19 lose-of-function alleles (all p<0.05). Our findings showed that ticagrelor/aspirin therapy possessed greater platelet inhibition and more rapid onset in platelet inhibition compared with clopidogrel/aspirin therapy both in carriers and non-carriers of CYP2C19 lose-of-function alleles with acute minor stroke or TIA.

• Authors: Mengyuan Zhou, Weiqi Chen, Yuesong Pan, Yi Lin, Xia Meng, Xingquan Zhao, Liping Liu, Jinxi Lin, Hao Li, Yongjun Wang, Yilong Wang
• Journal: Aging (Aging (Albany NY)) Vol. 13 Issue 3 Pg. 3994-4006 (12 19 2020) ISSN: 1945-4589 [Electronic] United States
• PMID: 33411687 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• CYP2C19 protein, human
• Cytochrome P-450 CYP2C19
• Ticagrelor
• Aspirin

Topics

• Aged
• Aspirin (pharmacology, therapeutic use)
• Blood Platelets (drug effects)
• Clopidogrel (pharmacology, therapeutic use)
• Cytochrome P-450 CYP2C19 (genetics)
• Drug Therapy, Combination
• Female
• Humans
• Ischemic Attack, Transient (drug therapy, epidemiology, genetics)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (pharmacology, therapeutic use)
• Polymorphism, Single Nucleotide (genetics)
• Randomized Controlled Trials as Topic
• Stroke (drug therapy, epidemiology, genetics)
• Ticagrelor (pharmacology, therapeutic use)