ArticleTherapeutics and clinical risk management2026
Effectiveness of CYP2C19 Genotype-Guided Antiplatelet Therapy Following Neurovascular Endovascular Procedures: A Prospective Non-Randomized Controlled Study.
Article in Therapeutics and clinical risk management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: CYP2C19 loss-of-function alleles are highly prevalent in Asian populations and may reduce the effectiveness of clopidogrel. This study aimed to evaluate the efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy in patients with symptomatic severe intracranial atherosclerotic stenosis undergoing neurovascular endovascular treatment (EVT). Methods: This prospective non-randomized controlled study enrolled 175 patients who underwent neurovascular intervention. Patients in the genotype-guided group (n=100) received individualized antiplatelet therapy according to CYP2C19 genotyping results, whereas patients in the conventional therapy group (n=75) received routine dual antiplatelet therapy with aspirin and clopidogrel. Safety events, 90-day neurological outcomes, and the cumulative incidence of ischemic events within one year were compared between groups. Results: The incidence of bleeding events did not differ significantly between the genotype-guided group and the conventional therapy group (1.0% vs 4.0%, P>0.05). At 90 days, a significantly higher proportion of patients achieved a favorable functional outcome (modified Rankin Scale score 0-1) in the genotype-guided group than in the conventional therapy group (84.0% vs 65.3%, P=0.004). At one year, the proportion of patients experiencing at least one ischemic event was significantly lower in the genotype-guided group than in the conventional therapy group (12.0% vs 26.7%, P=0.013). Multivariable Cox regression analysis demonstrated that patients in the conventional therapy group had a significantly higher risk of ischemic events during follow-up than those in the genotype-guided therapy group (HR: 2.723, 95% CI: 1.259-5.888, P = 0.011). Interaction analysis suggested that treatment effects differed according to device type, with a numerically greater benefit observed in the stent subgroup, although this finding should be considered exploratory. Conclusion: CYP2C19 genotype-guided antiplatelet therapy following neurovascular EVT was associated with improved neurological outcomes and a lower incidence of ischemic events without increasing bleeding risk. However, because ticagrelor exposure differed between treatment groups, the independent contribution of pharmacogenetic testing requires further confirmation in larger randomized studies.
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