Abstract
Objective
The dual antiplatelet therapy (DAT) with clopidogrel plus aspirin has been suggested by AHA/ASA guidelines for minor stroke (MS) and transient ischemic attack (TIA) patients. The purpose of this study was to find the potential subgroups that benefit from the DAT. We aimed to compare the efficacy of clopidogrel‐aspirin therapy with aspirin therapy in MS/TIA patients stratified by CYP2C19 genotype and risk profiles.
Methods
CYP2C19 loss‐of‐function allele (LoFA) carriers were defined as patients with either LoFA of *2 or *3. Low and high risk profile was defined as Essen stroke risk score (ESRS)<3 and ≥3, respectively. Stroke recurrence at one year was defined as primary outcome.
Results
In total 2933 MS/TIA patients, there were 1726 (58.8%) LoFA carriers and 1068 (36.4%) patients at high risk (ESRS≥3). No significant difference for stroke recurrence between clopidogrel‐aspirin group and aspirin alone group was found in LoFA carriers (11.2% vs 13.3%, HR, 0.83; 95% CI, 0.64~1.09). In Stratified analyses by CYP2C19 genotype and ESRS, HRs (95% CIs) of the clopidogrel‐aspirin therapy for stroke recurrence were 1.00 (0.70~1.42), 0.63 (0.41~0.97), 0.62 (0.40~0.96) and 0.52 (0.31~0.88) among subgroups of LoFA carriers at low risk, LoFA carriers at high risk, LoFA non‐carriers at low risk and LoFA non‐carriers at high risk, respectively, with p=0.021 for interaction.
Interpretation
Overall LoFA carriers do not benefit from DAT, but there is significant benefit for LoFA carriers who are at high risk. The benefit of clopidogrel in Chinese MS/TIA patients depends on CYP2C19 genotype and risk profile.
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