Optimizing Choice of Dual Antiplatelet Therapy in CYP2C19 Loss-of-Function Carriers

There is limited knowledge regarding the most efficacious antiplatelet treatment to reduce subsequent stroke risk for patients with CYP2C19 loss-of-function (LOF) alleles presenting with acute cerebrovascular events. Clopidogrel is an inactive prodrug and requires conversion to an active metabolite through the CYP2C19 enzyme.¹ Individuals who carry 2 LOF alleles for the CYP2C19 gene are poor metabolizers of clopidogrel, and clopidogrel may be less effective in these patients.¹ CYP2C19 LOF alleles are more common in East Asian populations. At least 1 CYP2C19 LOF allele is present in approximately 24% of non-Hispanic White individuals, 33% of Black individuals, 18% of Hispanic individuals, and 50% of Asian individuals.² Carriers of these LOF alleles were found to have a higher risk of ischemic stroke compared with noncarriers when treated with clopidogrel.³

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