j - JOUR T1 -替格瑞洛阿司匹林vs氯吡格雷阿司匹林CYP2C19轻度卒中或TIA功能丧失携带者的风险分级[j] - Neurology - JO - Neurology - SP - e497 LP - e504 DO - 10.1212/WNL.0000000000201454半岛投注体育官网六世- 100 - 5盟安信王盟-孟夏盟雪田AU -扬州颖左盟-菲利普·m .浴盟郝李盟Xuewei谢AU -晶晶盟锦溪林盟-仪陇王盟星泉李子晓赵盟-力平刘盟Zixiao李盟徐-江永盟杰盟-冯王盟伟峰陈盟-明华曹王盟- Jianhua李盟Yongjun Y1 - 2023/01/31 UR - //www.ebmtp.com/content/100/5/e497.abstract N2 -背景和目的基因型数据的氯吡格雷与阿司匹林急性小调半岛投注体育官网卒中或短暂性脑缺血发作(CHANCE)试验表明，氯吡格雷阿司匹林的疗效取决于CYP2C19基因型和风险概况。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)(分别为<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。 The primary safety outcome of severe or moderate bleeding did not differ based on risk profile (p = 0.24 for interaction), although the incidence of total bleeding was greater with ticagrelor aspirin than with clopidogrel aspirin among patients at low risk (p < 0.01 for interaction). 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 ER -