Observation on application effect of individualized treatments for ischemic stroke patients guided by the results of clopidogrel-related gene polymorphism and platelet aggregation tests

LI Zhaoquan; HUANG Jinshi; LI Tao; CHEN Yingdao; CHEN Xiaoling; WU Lifang

doi:10.3969/j.issn.1674-3806.2025.12.14

Abstract：Objective To observe the application effect of individualized treatments for ischemic stroke patients guided by the results of clopidogrel-related gene polymorphism and platelet aggregation tests.Methods A total of 120 patients with ischemic stroke who were admitted to Department of Neurology,Wuzhou Gongren Hospital from January 2022 to January 2024 were recruited and divided into research group and control group by random number table method,with 60 patients in each group.The control group was given conventional antiplatelet therapy[oral administration of clopidogrel(75mgq.d.)and aspirin(100 mg q.d.)].The research group was given conventional oral administration of aspirin(100 mg q.d.),and individualized treatment regimens were formulated according to the results of clopidogrel-related genes[including CYP2C19*2(rs4244285)、CYP2C19*3(rs4986893)、CYP2C19*17(rs12248560),ABCB1 C3435T(rs1045642)and CES1 G143E(rs71647871)]test and platelet aggregation test.The patients with CYP2C19 gene phenotypes of ultrarapid metabolizer(UM)and extensive metabolizer(EM)and ABCB1 C3435T carrying the G allele were treated with clopidogrel.The patients with CYP2C19 gene phenotypes of intermediate metabolizer(IM)and poor metabolizer(PM)and ABCB1 C3435T carrying the A allele were treated with ticagrelor.The patients with CYP2C19 gene phenotype of EM and ABCB1 C3435T of AA type,as well as those with CYP2C19 gene phenotype of IM and ABCB1 C3435T of GG type,were initially treated with clopidogrel.After 5 days of the medication,if the platelet adenosine diphosphate(ADP)receptor aggregation rate was less than 30%,clopidogrel treatment should be continued,and if the platelet ADP receptor aggregation rate was greater than or equal to30%,clopidogrel treatment should be switched to ticagrelor treatment.If the patients'CES1 G143E was CT type or TT type,ticagrelor was used for the treatment.The patients were followed up for 1 year to compare the occurrence of major adverse cardiovascular and cerebrovascular events(MACCE)between the two groups,and to analyze the impact of different genotypes on the prognosis of the patients receiving individualized treatment of clopidogrel.Results According to the results of clopidogrel-related gene polymorphism and platelet aggregation tests,a total of 28 patients in the research group had their medications adjusted.During the 1-year follow-up,no patients were lost to follow-up in either group.There were 21 cases of MACCE in the control group and 7 cases of MACCE in the research group.The research group had better results in terms of MACCE-free situation[HR(95%CI)=3.37(1.55-7.31),P=0.002].In the patients of the research group,there was no statistically significant difference in the occurrence of MACCE between the patients with CYP2C19 gene phenotypes of UM type/EM type and those with CYP2C19 gene phenotypes of IM type/PM type[HR(95%CI)=1.92(0.42-8.85),P=0.400],and there was no statistically significant difference in the occurrence of MACCE between the patients with ABCB1 C3435T gene of GG type and those with ABCB1 C3435T gene of GA type/AA type[HR(95%CI)=0.34(0.07-1.57),P=0.165].Conclusion Individualized treatments guided by the results of clopidogrel-related gene polymorphism and platelet aggregation tests can reduce the risk of MACCE in ischemic stroke patients.