期刊文章%A王安新%A夏bbb %A田雪%A左应婷%A Bath %A李昊%A谢学伟%A晶晶%A林锦曦%A王一龙%A赵兴全%A刘丽萍%A李子晓%A姜勇%A徐洁%A王峰%A陈伟峰%A曹明华%A李建华%A王永军%A替格瑞洛阿司匹林与氯吡格雷阿司匹林CYP2C19轻度卒中或TIA的功能丧失携带者按风险特征分层%D 2023% R 10.1212/WNL。背景与目的氯吡格雷联合阿司匹林治疗急性轻半岛投注体育官网微卒中或短暂性脑缺血发作(CHANCE)试验的基因型数据显示，氯吡格雷阿司匹林的疗效取决于CYP2C19基因型和风险谱。根据卒中复发风险对携带CYP2C19功能丧失(LOF)等位基因的患者进行分层可能对选择最佳抗血小板治疗具有重要意义。我们的目的是比较替格瑞洛阿司匹林和氯吡格雷阿司匹林对CYP2C19 LOF携带者轻度卒中或短暂性脑缺血发作(TIA)的疗效和安全性。方法采用替格瑞洛或氯吡格雷联合阿司匹林治疗高危急性非致残性脑血管事件II (CHANCE-2)试验。根据Essen卒中风险评分(ESRS)(分别<3[低风险]和≥3[高风险])定义低风险和高风险。结果共纳入6412例CYP2C19 LOF携带者;替格瑞洛阿司匹林与低风险患者主要结局(90天随访内新发卒中)风险降低相关(风险比[HR]， 0.65;95% CI, 0.48-0.82)，但在高危人群中没有(HR, 0.97;95% CI, 0.73-1.29)，与氯吡格雷阿司匹林相比(相互作用p = 0.02)。次要结果通常与主要结果走向相同。尽管在低风险患者中，替格瑞洛阿司匹林的总出血发生率高于氯吡格雷阿司匹林(相互作用的p < 0.01)，但重度或中度出血的主要安全结局并没有基于风险状况的差异(相互作用的p = 0.24)。 Analysis in the per-protocol population yielded similar results.Discussion This post hoc analysis of CHANCE-2 trial showed that CYP2C19 LOF carriers with minor stroke or TIA at low risk of recurrent stroke received a greater benefit from ticagrelor aspirin than from clopidogrel aspirin.Classification of Evidence This study provides Class II evidence that CYP2C19 LOF carriers with minor stroke or TIA at low risk, but not at high risk, of recurrent stroke (by the ESRS) received a greater benefit from ticagrelor aspirin than from clopidogrel aspirin.Trial Registration Information URL: www.clinicaltrials.gov. Unique identifier: NCT04078737.CAPRIE=Clopidogrel vs Aspirin in Patients at Risk of Ischemic Events; CHANCE=Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack; CHANCE-2=Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II; CYP=cytochrome p450; ESRS=Essen Stroke Risk Score; GUSTO=Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries; HR=hazard ratio; LOF=loss of function; REACH=REduction of Atherothrombosis for Continued Health; TIA=transient ischemic attack %U //www.ebmtp.com/content/neurology/100/5/e497.full.pdf