The Study Of Gene Detection In Antiplatelet Therapy In Patients With Ischemic Stroke

Objective To statistically analyze the distribution of aspirin GPla(C807T),GPla(G873A)alleles and clopidogrel CYP2C19*2,CYP2C19*3 alleles in the ischemic stroke population in this region.To study the efficacy and adverse reaction diversities of ischemic stroke patients being under different antiplatelet treatment regimens according to genotypic differences.Methods Totally 584 patients,who were diagnosed with ischemic stroke and received aspirin or clopidogrel monotherapy antiplatelet therapy in the Department of Neurology,Jiangdu People's Hospital,YangZhou City from July 1,2017 to December31,2018 were included in the study.Their medical records: gender,age,underlying conditions,and other general conditions were collected and considered as inclusion and exclusion criterias.According to the implementation of genetic testing or not,the patients were divided into Group A1(aspirin drug genetic testing),Group A2(without aspirin drug genetic testing),Group B1(with clopidogrel drug genetic testing),and Group B2(with no clopidogrel drug genetic testing).First,aspirin GPla(C807T),GPla(G873A)alleles or clopidogrel CYP2C19* 2,CYP2C19*3 alleles of patients were tested and analyzed and the gene distribution and genotype frequency in Yangzhou Jiangdu area were get based on the results.The patients in group A1 were divided into three types: aspirin sensitive,semi-resistant and resistant according to the results of genetic testing.The patients in group B1 were divided into clopidogrel extensive metabolizers,intermediate metabolizers and poor metabolizers.and recieved different medication regimens accordingly.Sensitive type(extensive metabolizers)were treated with a standard dose,semi-resistance type(intermediate metabolizers)received an increasing dose treatment,and resistance type(poor metabolizers)switched to another drug and maintained antiplatelet therapy for more than six months.A six months follow-up,including telephone follow-up,outpatient follow-up and re-admission follow-up was performed after discharge..The parameters included adverse reaction occurrence such as bleeding,original disease progression or re-admission,and other discomforts.T test was used to compare the differences ingender,age,NIHSS score,and underlying diseases(diabetes,hypertension hyperlipidemia)between two groups.X2 test was used to compare the differences in re-admission rate and adverse reactions between two groups.Results The final number of patients enrolled was 138 patients in group Al,153 patients in group A2,141 patients in group Bl,and 152 patients in group B2.The general status of the patients such as gender,age,and underlying diseases were compared between groups A1 and A2,as well as B1 and B2.At the end of the follow-up period the readmission rate of group A1 was 0.7% and the incidence of adverse reactions was 8.7%.The readmission rate of A2 was 4.6% and the incidence of adverse reactions was 12.4%.The readimission rate of group Bl was 1.4% and the incidence reactions was 6.6%,the re-admission rate of group B2 was 6.4%,and the incidence of adverse reactions was 13.8%.Comparing the re-admission rates of A1,A2 and B1,B2 respectively,the differences were statistically significant and the adverse reactions were not.Conclusion The detection of aspirin and clopidogrel resistance-related genes can improve the efficacy of antiplatelet therapy in ischemic stroke patients,without increasing adverse reactions incidence.