MONDAY, July 10, 2023 (HealthDay News) — For patients with minor stroke or transient ischemic attack (TIA) who carry the CYP2C19 loss-of-function allele, those with obesity receive more clinical benefit from ticagrelor-acetylsalicylic acid (ASA) than clopidogrel-ASA, according to a study published online July 10 in CMAJ, the journal of the Canadian Medical Association.
Jia Zhang, M.D., from The China National Clinical Research Center for Neurological Diseases in Beijing, and colleagues conducted a randomized, double-blind trial involving patients with minor stroke or TIA who carried the CYP2C19 loss-of-function allele. Participants were randomly assigned to receive ticagrelor-ASA or clopidogrel-ASA. Data were included for 6,412 patients: 876 were classified as obese and 5,536 were classified as nonobese.
The researchers found that among patients with obesity, ticagrelor-ASA was associated with a significantly lower rate of stroke within 90 days compared with clopidogrel-ASA (5.4 versus 11.3 percent; hazard ratio, 0.51; 95 percent confidence interval, 0.30 to 0.87), but not among those without obesity (6.0 versus 7.0 percent; hazard ratio, 0.84; 95 percent confidence interval, 0.69 to 1.04). No differences were seen in the rates of severe or moderate bleeding by body mass index group.
“Body mass index influences the efficacy of ticagrelor-ASA versus clopidogrel-ASA among patients with minor ischemic stroke or TIA who carry a CYP2C19 loss-of-function allele,” the authors write. “Clopidogrel appears to lose its efficacy among patients with obesity.”
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