ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2021
CYP2C19 Loss-of-Function is Associated with Increased Risk of Ischemic Stroke after Transient Ischemic Attack in Intracranial Atherosclerotic Disease.
Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Risk of Ischemic Stroke After Transient Ischemic Attack in Patients Receiving Comprehensive Versus Noncomprehensive Diagnostic Workup: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2025Pooled it
- Clinical and cost-effectiveness of clopidogrel resistance genotype testing after ischaemic stroke or transient ischaemic attack: a systematic review and economic model.Health technology assessment (Winchester, England) · 2024Pooled it
- The role ofExpert review of clinical pharmacology · 2022Pooled it
- Current status and future perspectives of platelet function-guided precision antiplatelet therapy for patients with cerebral infarction.Neuroprotection (Chichester, England) · 2026Review
- Development and External Validation of an Electronic Health Record-Derived Model for 30-Day Periprocedural Ischemic Stroke.Journal of the American Heart Association · 2026Article
- Comprehensive Molecular Evaluation of Transcription Factor 7-like 2, Long Noncoding RNA (ANRIL), and CYP2C19*17 Gene Variants and Their Association with Predisposition and Progression in Stroke Patients.Cellular and molecular neurobiology · 2025Article
- Current perspectives on the pathogenesis of cerebral atherosclerosis.Journal of inflammation (London, England) · 2025Review
- CYP2C19 loss-of-function variants are independent risk factors for premature cerebral infarction: a hospital based retrospective study.BMC cardiovascular disorders · 2024Article
- Review
- CYP2C19 loss-of-function is associated with increased risk of hypertension in a Hakka population: a case-control study.BMC cardiovascular disorders · 2023Article
- Article
- Differences in the Proportion of CYP2C19 Loss-of-Function Between Cerebral Infarction and Coronary Artery Disease Patients.International journal of general medicine · 2023Article
- The Implementation of Pharmacogenetics in the United Kingdom.Handbook of experimental pharmacology · 2023Article
- Characterizing pharmacogenetic programs using the consolidated framework for implementation research: A structured scoping review.Frontiers in medicine · 2022Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesIntracranial atherosclerotic disease (ICAD) is responsible for 8-10% of acute ischemic strokes, and resistance to antiplatelet therapy is prevalent. CYP2C19 gene loss-of-function (up to 45% of patients) causes clopidogrel resistance. For patients with asymptomatic ICAD and ICAD characterized by transient ischemic attack (TIA), this study measures the effect of CYP2C19 loss-of-function on ischemic stroke risk during clopidogrel therapy. MATERIALS AND
methodsFrom a deidentified database of medical records, patients were selected with ICD-9/10 code for ICAD, availability of CYP2C19 genotype, clopidogrel exposure, and established patient care. Dual-antiplatelet therapy patients were included. Patients with prior ischemic stroke, other neurovascular condition, intracranial angioplasty/stenting, or observation time <1 month were excluded. Time-to-event analysis using Cox regression was conducted to model first-time ischemic stroke events based on CYP2C19 loss-of-function allele and adjusted for age, gender, race, length of aspirin, length of concurrent antiplatelet/anticoagulant treatment, diabetes, coagulopathy, hypertension, heart disease, atrial fibrillation, and lipid disorder. Subset analyses were performed for asymptomatic and post-TIA subtypes of ICAD.
resultsA total of 337 patients were included (median age 68, 58% male, 88% Caucasian, 26% CYP2C19 loss-of-function). A total of 161 (47.8%) patients had TIA at time of ICAD diagnosis, while 176 (52.2%) were asymptomatic. First-time ischemic stroke was observed among 20 (12.4%) post-TIA ICAD patients and 17 (9.7%) asymptomatic ICAD patients. Median observation time was 2.82 [IQR 1.13-5.17] years. CYP2C19 loss-of-function allele was associated with ischemic stroke event (HR 2.2, 95% CI 1.1-4.3, p=0.020) after adjustment. Post-TIA ICAD patients had a higher risk of ischemic stroke from CYP2C19 loss-of-function (HR 3.4, 95% CI 1.4-8.2, p=0.006).
conclusionsCYP2C19 loss-of-function was associated with 3-fold increased risk of first-time ischemic stroke for ICAD patients treated with clopidogrel after TIA. This effect was not observed for asymptomatic ICAD. CYP2C19-guided antiplatelet selection may improve stroke prevention in ICAD after TIA.
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