Clopidogrel response in ischemic stroke patients: Is polymorphism or gender more important? Results of the CRISP study. (June 2020)

• Record Type: Journal Article
• Authors: Gairolla, Jitender; Ahluwalia, Jasmina; Khullar, Madhu; Kler, Rupinder; Kishore, Kamal; Medhi, Bikash; Modi, Manish; Kumar, Mukesh; Kumar, Ashok; Khurana, Dheeraj
• Is Part Of: Journal of clinical neuroscience. Volume 76(2020)
• Page Start: 81
• Page End: 86
• Publication Date: 2020-06
• Subjects: ADP adenine dinucleotide phosphate -- AOR adjusted odds ratio -- CLP clopidogrel -- CI confidence intervals -- CAD coronary artery disease -- CYP Cytochrome P 450 system -- CV coefficient of variation -- CT computed tomography -- DNA deoxyribonucleic acid -- DM diabetes mellitus -- DME drug metabolising enzymes -- EDTA ethylenediaminetetraacetic acid -- HWE Hardy Weinberg equilibrium -- IQR interquartile range -- IS ischemic stroke -- LOF loss of function -- MAF minor allele frequencies -- MRI magnetic resonance imaging -- ng nanogram -- pg picogram -- PCR polymerase chain reaction -- PPI proton pump inhibitor -- SNP single nucleotide polymorphism; Anti-platelet effect -- Clopidogrel -- CYP -- Ischemic stroke -- P2Y12; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.04.038
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Clopidogrel which is an antiplatelet agent is a pro drug and its antipatelet effect maybe infuenced by genetic polymorphisms of the CYP 2C family. Clopidogrel resistance was associated with the female gender which may be related to higher levels of leptin. Abstract: Clopidogrel (CLP) is a second generation thienopyridine drug commonly used in secondary prevention of ischemic stroke (IS). Its antiplatelet response maybe variable due to genetic and non-genetic factors. Adipokines may affect platelet aggregation through ADP mediated platelet signalling. However, the combined effect of CYP genetic variants and adipokines on antiplatelet response of clopidogrel is unclear. Patients of IS/Transient ischemic attack (TIAs) within 3 months were prospectively screened following clopidogrel treatment. Major exclusions were cardioembolic and non atherosclerotic strokes. Antiplatelet effect of clopidogrel along with adipokine (Leptin and adiponectin) levels and genotyping of CYP, P2Y12 gene were investigated. Rare genetic variants were confirmed by DNA sequencing. 204 patients with ischemic stroke/TIAs were screened and 163 were recruited. 85 (52.1%) patients were poor responders to clopidogrel. Antiplatelet response to clopidogrel was weaker in females [Median 8.0 (IQR: 3.0–14.0)] compared to males [Median 5.0 (IQR: 2.0–10.0)]. In female subgroup analysis, association was found among high leptin levels and PPI (+) usage in poor responders. None of the genetic variants (CYP2C19*2, *3, *4*, CYP2C9*3, CYP2B6 and P2Y12) were found to influence the antiplatelet effects (p > 0.05). On multivariable logistic regression, a poor clopidogrel response was associated with female gender (Adjusted OR 2.55, 95% CI: 1.05–6.18) and PPI usage (Adjusted OR 2.42, 95% CI: 1.09–5.34). Despite a high prevalence of clopidogrel resistance in the North Indian stroke patients, female gender rather than genetic polymorphisms of CYP and P2Y12 genes may influence its antiplatelet effect. Further research may ascertain the role of gender on clopidogrel response.