The efficacy and safety of aspirin-ticagrelor vs. aspirin-clopidogrel in ischemic stroke patients with cerebral artery stenting

作者全名：Liu, Chenxi; Liu, Mingsu; Yang, Xun; Luo, Tingting; Wang, Jinping; Li, Guangqin

作者地址：[Liu, Chenxi; Luo, Tingting; Li, Guangqin] Chongqing Med Univ, Affiliated Hosp 1, Dept Neurol, Chongqing 400016, Peoples R China; [Liu, Mingsu] Fudan Univ, Zhongshan Hosp, Dept Neurol, Shanghai 200032, Peoples R China; [Yang, Xun] Hechuan Dist Peoples Hosp, Dept Neurol, Chongqing 401500, Peoples R China; [Wang, Jinping] Chongqing Univ, Cent Hosp, Dept Neurol, Chongqing 400050, Peoples R China

通信作者：Li, GQ (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Neurol, Chongqing 400016, Peoples R China.

来源：CLINICAL NEUROLOGY AND NEUROSURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001206816700001

JCR分区：Q2

影响因子：1.8

年份：2024

卷号：239

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：Stroke; Antiplatelet; Ticagrelor; Cerebral artery stent

摘要：Objective: First, the efficacy and safety of aspirin-ticagrelor after cerebral artery stenting in ischemic stroke patients is controversial. Second, there is a gap in the research on guiding two antiplatelet therapy (DAPT) after stenting based on the CYP2C19 genotype. Methods: This retrospective study included patients who underwent cerebral artery stenting at the First Affiliated Hospital of Chongqing Medical University from January 2019 to February 2023. We divided them into the aspirin-clopidogrel group and aspirin-ticagrelor group and carefully collected baseline information laboratory data and imaging results from the patients. The efficacy outcomes were 30 days recurrent stroke, 90 days recurrent stroke, and 180 days recurrent stroke, and the safety outcome was intracranial hemorrhage. T -tests or Fisher's tests were performed for study outcomes in both groups of patients. Outcome: A total of 372 patients were included. For efficacy outcomes, aspirin-ticagrelor was associated with a reduced risk of 180 days recurrent stroke, in patients with CYP2C19 LOF allele (OR = 0.426, CI = 0.184-0.986, P = 0.042) and CYP2C19 intermediate metabolic genotype (OR = 0.237, CI = 0.026-1.034, P = 0.044), compared with aspirin-clopidogrel. There was no significant difference in the rate of intracranial hemorrhage (ICH) between patients with aspirin-clopidogrel and aspirin-ticagrelor, regardless of overall (OR = 1.221, CI = 0.115-7.245, P = 0.683), CYP2C19 LOF allele carriers (OR = 1.226, CI = 0.411-3.658, P = 0.715), or CYP2C19 intermediate metabolizer (OR = 1.221, CI = 0.115-7.245, P = 0.683). No significant differences were found between the two DAPTs on other efficacy and safety outcomes. Conclusion: A cohort study found that aspirin-ticagrelor was significantly superior to aspirin-clopidogrel in reducing 180 days recurrent stroke in CYP2C19 LOF allele carriers and CYP2C19 intermediate metabolizers. There was no significant difference between aspirin-ticagrelor and aspirin-clopidogrel in the risk of intracranial hemorrhage in terms of ICH rates.

基金机构：Chongqing Natural Science Foundation Project [cstc2021jcyj-msxmX0709]

基金资助正文：<B>Funding</B> Chongqing Natural Science Foundation Project (cstc2021jcyj-msxmX0709)