PT -期刊文章盟安信王盟-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 TI - Ticagrelor阿司匹林和氯吡格雷阿司匹林在< em > CYP2C19 < / em >功能丧失运营商与小中风或TIA - 10.1212 / WNL通过风险分层援助。0000000000201454 DP - 2023年1月31日TA -神经病首页学PG - e497 e504 VI - 100 IP - 5 4099 - //www.ez-admanager.com/content/100/5/e497.short 4100 - //www.ez-admanager.com/content/100/5/e497.full所以Neurology2023 1月31日;100 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)试验表明,氯吡格雷阿司匹林的效果取决于CYP2C19基因型和风险状况。分层的病人进行CYP2C19功能丧失(LOF)等位基因根据中风复发的风险可能是重要的,以选择最佳的抗血小板治疗。我们旨在比较的有效性和安全性ticagrelor阿司匹林与氯吡格雷阿司匹林CYP2C19 LOF运营商与小中风或短暂性脑缺血发作(TIA)通过风险分层。方法从Ticagrelor得到的数据或氯吡格雷与阿司匹林在高危急性Nondisabling患者脑血管事件二世(机会)试验。低风险和高风险概要文件定义了埃森中风风险评分(esr) (& lt; 3(低风险)和≥3(高风险),分别)。结果共有6412名CYP2C19 LOF运营商被录取;ticagrelor阿司匹林与降低风险的主要结果(新中风之后90天内后续)患者在低风险(风险比[HR], 0.65;95%可信区间,0.48 - -0.82),但不是在那些高危(HR 0.97;95%可信区间,0.73 - -1.29),与之相比,氯吡格雷阿司匹林作用(p = 0.02)。二次结果通常作为主要方向相同的结果。严重或中度出血的主要安全结果没有差别基于风险相互作用(p = 0.24),尽管总出血的发生率大ticagrelor阿司匹林与氯吡格雷阿司匹林在低风险患者(p & lt; 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