@article {Liu10.1212 / WNL。刘0000000000206775,作者={慧慧晶晶和安信王秦许李子晓夏孟和李郝Zixiao李和Yongjun王},title = {Genotype-Guided双重抗血小板治疗轻微中风或短暂性脑缺血发作与单个小皮层下梗死},elocation-id = {10.1212 / WNL。={2023}0000000000206775},年,doi = {10.1212 / WNL。出版商0000000000206775}= {Wolters Kluwer健康,公司代表美国神经病学学会},文摘={背景和目的:单小皮层下梗死(拟建)是一种重要的中风亚型。半岛投注体育官网最优抗血小板药物治疗缺血性中风患者一个拟建尚不清楚。我们旨在测试ticagrelor-aspirin预防卒中复发的疗效和安全性拟建患者Ticagrelor或氯吡格雷与阿司匹林在高危患者急性Nondisabling脑血管事件二世(机会)试验。方法:在他的试验中,患者轻微中风或短暂性脑缺血发作(TIA)进行CYP2C19功能丧失(LOF)等位基因被随机分配在24小时内出现症状后,要么ticagrelor-aspirin(安慰剂氯吡格雷+加载180毫克剂量的ticagrelor 1天,紧随其后的是90毫克每天两次在90天2 {\ textendash})或clopidogrel-aspirin(安慰剂ticagrelor +加载300毫克剂量的氯吡格雷1天,紧随其后的是75毫克每日90天2 {\ textendash})。阿司匹林是应用在前21天。患者一个拟建(diffusion-weighted成像病变直径< = 20 mm)包含在这一分析,进一步分为两种类型根据他们是否负责任的颅内动脉狭窄(英格尔):拟建+英格尔和SSSI-ICAS。主要功效的结果是一个新的行程在90天。结果:在2143名符合条件的患者中,340年负责英格尔和1803没有。 Ticagrelor-aspirin reduced stroke recurrence among all SSSI patients (HR: 0.54; 95\% CI: 0.38-0.79; P=0.001) compared to clopidogrel-aspirin. Stroke recurrence occurred in 35/901 (3.9\%) patients with SSSI-ICAS on ticagrelor-aspirin and in 72/902 (8.0\%) on clopidogrel-aspirin (HR: 0.45; 95\% CI: 0.29-0.68; P\<0.001). In patients with SSSI+ICAS, the corresponding event rates were 14/176 (8.2\%) and 13/164 (7.9\%), respectively (HR: 1.20; 95\% CI: 0.45-3.23; P=0.71; P for interaction=0.08). The risk of moderate to severe bleeding only occurred in SSSI-ICAS patients (5/901 [0.6\%] vs. 5/902 [0.6\%]).Conclusions: In this prespecified substudy, ticagrelor-aspirin was superior to clopidogrel-aspirin in reducing the risk of stroke at 90 days among SSSI patients who carried CYP2C19 LOF allele(s). Although there was no treatment-by-heterogeneous etiology interaction, a greater absolute risk reduction of stroke was observed in patients with SSSI-ICAS than in those with SSSI+ICAS.CYP2C19,}, issn = {0028-3878}, URL = {//www.ebmtp.com/content/early/2023/01/25/WNL.0000000000206775}, eprint = {//www.ebmtp.com/content/early/2023/01/25/WNL.0000000000206775.full.pdf}, journal = {Neurology} }