Aspirin + Clopidogrel Effectiveness in TIA Depends on CYP2C19 Loss-of-Function Allele Interview with:

Dr. Yongjun Wang  Principal Investigator No. 6 Tiantanxili Dongcheng District, Beijing, China

Dr. Yongjun Wang

Dr. Yongjun Wang 
Principal Investigator
No. 6 Tiantanxili
Dongcheng District, Beijing, China What is the background for this study? What are the main findings?

Response: Clopidogrel requires conversion to an active metabolite by hepatic cytochrome p450 (CYP) iso-enzymes to exert an antiplatelet effect, and polymorphisms of the CYP2C19 gene have been identified as strong predictors of clopidogrel nonresponsiveness. However, data are limited regarding the association between CYP2C19 genetic variants and clinical outcomes of clopidogrel-treated patients with minor stroke or transient ischemic attack.

The main findings of this study is that the combined treatment of clopidogrel and aspirin compared with aspirin alone reduced the risk of a new stroke only in the subgroup of patients with minor ischemic stroke or TIA who were not carriers of the CYP2C19 loss of function alleles. What should readers take away from your report?

Response: The CYP2C19 loss-of-function carrier genotypes was associated with less protection from subsequent stroke and composite vascular events for patients with acute minor stroke or TIA treated with clopidogrel and aspirin, compared with non-carrier status. What recommendations do you have for future research as a result of this study?

Response: Search for effective treatment alternative for CYP2C19 loss-of-function carriers with stroke or TIA. Varying the dose of clopidogrel or shift to new antiplatelet agents based on genetic results may be another alternative. Is there anything else you would like to add?

Response: It will be important to compare the association of CYP2C19 variants with efficacy of clopidogrel in a different population before applying these results to non-Asian populations. Thank you for your contribution to the community.


Wang Y, Zhao X, Lin J, et al. Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack. JAMA.Published online June 23, 2016. doi:10.1001/jama.2016.8662.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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