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| Significance of CYP2C19 Gene Polymorphism in Guiding Antiplatelet Drug Selection Therapy |
| LAI Kaisheng, et al |
| Bestnovo (Beijing) Medical Laboratory, Beijing 102206, China |
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Abstract Objective: To investigate the role of CYP2C19 gene polymorphism in guiding the use of ticagrelor after percutaneous transluminal angioplasty (PTA) in patients with acute ischemic stroke (AIS). Methods: A total of 525 patients with AIS who underwent PTA from January 2019 to March 2021 were enrolled as the research subjects. According to the results of CYP2C19 genotyping, patients were divided into three groups. 185 patients (35.24%) in group A (rapid metabolic type); 259 patients (49.34%) in group B (intermediate metabolic type); 81 patients (15.43%) in group C (poor metabolic type). Group B and C were further subdivided into doubled-clopidogrel group B1 and C1, ticagrelor group B2 and C2 randomly. Stroke, death from any cause, recurrent ischemic stroke, disability, bleeding and dyspnea within 3 months after operation were followed up to evaluate the effectiveness and safety. Results: After PTA, the platelet aggregation rate in group B1 was significantly higher than that in group B2 (P＜0.05); the platelet aggregation rate in group C1 after PTA was significantly higher than that in group C2 (P＜0.05). Secondary outcomes and disability events happened much more frequently in group B1 than in group B2 (P＜0.05), while total bleeding events, minimal bleeding events and dyspnea occurred much more frequently in group B2 than in group B1 (P＜0.05). The incidences of primary outcomes, secondary outcomes and disability in group C1 were obviously increased than incidences of those in group C2 (P＜0.05). Conclusion: For patients with AIS undergoing PTA in CYP2C19 intermediate metabolic type with low risk of bleeding, the use of tigretol is recommended instead of dual-dose clopidogrel, and for patients with AIS undergoing PTA in CYP2C19 slow metabolic type, the direct use of tigretol is recommended as a clinically important way to reduce the disability rate of acute ischaemic stroke, the risk of recurrent cerebrovascular disease after surgery and to improve the prognosis.
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2022, Vol. 28 
