Clopidogrel response in ischemic stroke patients: Is polymorphism or gender more important? Results of the CRISP study

被引:6
作者
Gairolla, Jitender [1 ,2 ]
Ahluwalia, Jasmina [3 ]
Khullar, Madhu [4 ]
Kler, Rupinder [5 ]
Kishore, Kamal [6 ]
Medhi, Bikash [7 ]
Modi, Manish [8 ]
Kumar, Mukesh [8 ]
Kumar, Ashok [9 ]
Khurana, Dheeraj [8 ]
机构
[1] Postgrad Inst Med Educ & Res, Dept Community Med, Chandigarh 160012, India
[2] Postgrad Inst Med Educ & Res, Sch Publ Hlth, Chandigarh 160012, India
[3] Postgrad Inst Med Educ & Res, Dept Hematol, Chandigarh 160012, India
[4] Postgrad Inst Med Educ & Res, Dept Expt Med & Biotechnol, Chandigarh 160012, India
[5] Dayanand Med Coll & Hosp, R&D Ctr, Mol Genet Lab, Ludhiana 141001, Punjab, India
[6] Postgrad Inst Med Educ & Res, Dept Biostat, Chandigarh 160012, India
[7] Postgrad Inst Med Educ & Res, Dept Pharmacol, Chandigarh 160012, India
[8] Postgrad Inst Med Educ & Res, Dept Neurol, Chandigarh 160012, India
[9] Postgrad Inst Med Educ & Res, Natl Inst Nursing Educ, Chandigarh 160012, India
关键词
Anti-platelet effect; Clopidogrel; CYP; Ischemic stroke; P2Y12; ACTIVE METABOLITE; CYP2C19; PHARMACOKINETICS; RESISTANCE; THERAPY; PHARMACODYNAMICS; AGGREGOMETRY; INHIBITORS; INSIGHTS; WOMEN;
D O I
10.1016/j.jocn.2020.04.038
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Clopidogrel (CLP) is a second generation thienopyridine drug commonly used in secondary prevention of ischemic stroke (IS). Its antiplatelet response maybe variable due to genetic and non-genetic factors. Adipokines may affect platelet aggregation through ADP mediated platelet signalling. However, the combined effect of CYP genetic variants and adipokines on antiplatelet response of clopidogrel is unclear. Patients of IS/Transient ischemic attack (TIAs) within 3 months were prospectively screened following clopidogrel treatment. Major exclusions were cardioembolic and non atherosclerotic strokes. Antiplatelet effect of clopidogrel along with adipokine (Leptin and adiponectin) levels and genotyping of CYP, P2Y12 gene were investigated. Rare genetic variants were confirmed by DNA sequencing. 204 patients with ischemic stroke/TIAs were screened and 163 were recruited. 85 (52.1%) patients were poor responders to clopidogrel. Antiplatelet response to clopidogrel was weaker in females [Median 8.0 (IQR: 3.0-14.0)] compared to males [Median 5.0 (IQR: 2.0-10.0)]. In female subgroup analysis, association was found among high leptin levels and PPI (+) usage in poor responders. None of the genetic variants (CYP2C19*2,*3,*4*, CYP2C9*3, CYP2B6 and P2Y12) were found to influence the antiplatelet effects (p > 0.05). On multivariable logistic regression, a poor clopidogrel response was associated with female gender (Adjusted OR 2.55, 95% CI: 1.05-6.18) and PPI usage (Adjusted OR 2.42, 95% CI: 1.09-5.34). Despite a high prevalence of clopidogrel resistance in the North Indian stroke patients, female gender rather than genetic polymorphisms of CYP and P2Y12 genes may influence its antiplatelet effect. Further research may ascertain the role of gender on clopidogrel response. (C) 2020 Elsevier Ltd. All rights reserved.
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页码:81 / 86
页数:6
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