Research Paper Volume 13, Issue 3 pp 3994—4006
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
- 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- 2 China National Clinical Research Center for Neurological Diseases, Beijing, China
- 3 Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- 4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- 5 Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Received: August 5, 2020 Accepted: November 8, 2020 Published: December 19, 2020https://doi.org/10.18632/aging.202366
How to Cite
Copyright: © 2020 Zhou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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.
TIA: transient ischemic attack; LOF: loss of function; CYP: cytochrome p450; SOCRATES: The Acute Stroke or Transient Ischemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes trial; PRINCE: the Platelet Reactivity In Non-disabling Cerebrovascular Events study; HOPR: high on-treatment platelet reactivity; IPA: inhibition of platelet aggregation; PRU: P2Y12 reaction unit; RR: risk ratio; HR: hazard ratios; CI: confidence intervals.