阿司匹林替格瑞与阿司匹林氯吡格雷的比较CYP2C19功能丧失患者与轻度脑卒中或TIA患者的风险分级[j] . Neurology . JO Neurology . FD . Lippincott Williams 半岛投注体育官网& Wilkins [j] . doi: 10.1212/WNL.0000000000201454签证官100年夏王是5 A1安信A1孟A1雪田A1扬州颖左A1菲利普·m .浴A1李郝A1 Xuewei谢A1晶晶林A1锦西A1仪陇王A1星泉赵A1力平刘李子晓A1 Zixiao李A1勇江A1杰徐A1冯王A1伟峰陈A1,明华曹A1 Jianhua李A1 Yongjun王年2023 UL //www.ebmtp.com/content/100/5/e497.abstract AB背景和目的基因型数据的氯吡格雷与阿司匹林在急性小中风或短暂性脑缺血发作(机会)试验显示半岛投注体育官网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<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