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Review

Genotype-guided dual antiplatelet therapy in cerebrovascular disease: assessing the risk and benefits for ethnic populations

ORCID Icon, &
Pages 621-630 | Received 12 Apr 2023, Accepted 04 Aug 2023, Published online: 13 Aug 2023

References

  • International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke. Lancet. 1997 May 31;349(9065): 1569–1581. doi: 10.1016/S0140-6736(97)04011-7
  • Chen ZM. CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke. Lancet. 1997 Jun 7;349(9066):1641–1649.
  • Karve S, Levine D, Seiber E, et al. Trends in ambulatory prescribing of antiplatelet therapy among US ischemic stroke patients: 2000–2007. Adv Phar Sc. 2012 Dec 5;2012:1–8.
  • Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American heart association/American stroke association. Stroke. 2021 Jul;52(7):e364–467. doi: 10.1161/STR.0000000000000375
  • Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013 Jul 4;369(1):11–19.
  • Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018 Jul 19;379(3):215–225.
  • Awtry EH, Loscalzo JA. Aspirin. Circulation. 2000 Mar 14;101(10):1206–1218.
  • Cattaneo M. New P2Y12 inhibitors. Circulation. 2010 Jan 5;121(1):171–179.
  • Marnat G, Finistis S, Delvoye F, et al. Safety and efficacy of cangrelor in acute stroke treated with mechanical thrombectomy: endovascular treatment of ischemic stroke registry and meta-analysis. AJNR Am J Neuroradiol. 2022 Mar 1;43(3):410–415.
  • Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2019 Dec;50(12):e344–418. doi: 10.1161/STR.0000000000000211
  • Ciccone A, Motto C, Abraha I, et al. Glycoprotein IIb‐IIIa inhibitors for acute ischaemic stroke. Cochrane Db Syst Rev. 2014;2014(3). doi: 10.1002/14651858.CD005208.pub3
  • Violi F, Calvieri C, Ferro D, et al. Statins as antithrombotic drugs. Circulation. 2013;127(2):251–257. doi: 10.1161/CIRCULATIONAHA.112.145334
  • Skowasch D, Viktor A, Schneider-Schmitt M, et al. Differential antiplatelet effects of angiotensin converting enzyme inhibitors: comparison of ex vivo platelet aggregation in cardiovascular patients with ramipril, captopril and enalapril. Clin Res Cardiol. 2006;95(4):212–216. doi: 10.1007/s00392-006-0363-1
  • Hankey GJ, Eikelboom JW. Aspirin resistance. Lancet. 2006 Feb 18;367(9510):606–617.
  • Vane JR, Botting RM. The mechanism of action of aspirin. Thromb Res. 2003 Jun 15;110(5–6):255–258.
  • Goodman T, Ferro A, Sharma P. Pharmacogenetics of aspirin resistance: a comprehensive systematic review. Brit J Clin Pharmaco. 2008 Aug;66(2):222–232. doi: 10.1111/j.1365-2125.2008.03183.x
  • Floyd CN, Ferro A. The PlA1/A 2 polymorphism of glycoprotein IIIa in relation to efficacy of antiplatelet drugs: a systematic review and meta‐analysis. Brit J Clin Pharmaco. 2014 Mar;77(3):446–457. doi: 10.1111/bcp.12204
  • Wang J, Liu J, Zhou Y, et al. Association among PlA1/A2 gene polymorphism, laboratory aspirin resistance and clinical outcomes in patients with coronary artery disease: an updated meta-analysis. Sci Rep-UK. 2019 Sep 11;9(1):13177.
  • Goodman T, Sharma P, Ferro A. The genetics of aspirin resistance. Int J Clin Pract. 2007 May;61(5):826–834. doi: 10.1111/j.1742-1241.2007.01344.x
  • Floyd CN, Ellis BH, Ferro A, et al. The PlA1/A2 polymorphism of glycoprotein IIIa as a risk factor for stroke: a systematic review and meta-analysis. Plos One. 2014 Jul 2;9(7):e100239.
  • Oksala NK, Heikkinen M, Mikkelsson J, et al. Smoking and the platelet fibrinogen receptor glycoprotein IIb/IIIA PlA1/A2 polymorphism interact in the risk of lacunar stroke and midterm survival. Stroke. 2007 Jan 1;38(1):50–55.
  • Kim HO, Jin Y, Kickler TS, et al. Gene frequencies of the five major human platelet antigens in African American, white, and Korean populations. Transfusion. 1995 Oct;35(10):863–867. doi: 10.1046/j.1537-2995.1995.351096026369.x
  • Wagner KR, Giles WH, Johnson CJ, et al. Platelet glycoprotein receptor IIIa polymorphism P1A2 and ischemic stroke risk: the stroke prevention in young women study. Stroke. 1998 Mar;29(3):581–585. doi: 10.1161/01.STR.29.3.581
  • Juárez-Velázquez R, Canto P, Canto-Cetina T, et al. Analysis of polymorphisms in genes (AGT, MTHFR, GPIIIa, and GSTP1) associated with hypertension, thrombophilia and oxidative stress in Mestizo and Amerindian populations of México. Dis Markers. 2010 Jan 1;28(5):323–331.
  • Salem AH, Hamed AE, Abdalla EM, et al. Gene frequencies of human platelet alloantigens 1–5 in two Arab populations. Blood Transfus. 2014 Jan;12(Suppl 1):s281. doi: 10.2450/2013.0220-12
  • Halle L, Bigot A, Mulen‐Imandy G, et al. HPA polymorphism in sub‐Saharan African populations: Beninese, Cameroonians, Congolese, and Pygmies. Tissue Antigens. 2005 Mar;65(3):295–298. doi: 10.1111/j.1399-0039.2005.00360.x
  • Naran NH, Chetty N, Crowther NJ. The prevalence of the platelet glycoprotein IIIa PlA1/A2 polymorphism in three South African ethnic groups and its effect on platelet function. Thromb Res. 2008 Dec 1;123(2):316–323.
  • Tanaka S, Ohnoki S, Shibata H, et al. Gene frequencies of human platelet antigens on glycoprotein IIIa in Japanese. Transfusion. 1996 Sep;36(9):813–817. doi: 10.1046/j.1537-2995.1996.36996420760.x
  • Lim J, Lal S, Ng KC, et al. Variation of the platelet glycoprotein IIIa PIA1/A2 allele frequencies in the three ethnic groups of Singapore. Int J Cardiol. 2003 Aug 1;90(2–3):269–273.
  • Chen CH, Lo YK, Ke D, et al. Platelet glycoprotein Ia C807T, Ib C3550T, and IIIa PlA1/A2 polymorphisms and ischemic stroke in young Taiwanese. J Neurol Sci. 2004 Dec 15;227(1):1–5.
  • Mega JL, Simon T. Pharmacology of antithrombotic drugs: an assessment of oral antiplatelet and anticoagulant treatments. Lancet. 2015 Jul 18;386(9990):281–291.
  • Farid NA, Kurihara A, Wrighton SA. Metabolism and disposition of the thienopyridine antiplatelet drugs ticlopidine, clopidogrel, and prasugrel in humans. J Clin Pharmacol. 2010 Feb;50(2):126–142. doi: 10.1177/0091270009343005
  • Rehmel JL, Eckstein JA, Farid NA, et al. Interactions of two major metabolites of prasugrel, a thienopyridine antiplatelet agent, with the cytochromes P450. Drug Metab Dispos. 2006 Apr 1;34(4):600–607.
  • Pan Y, Chen W, Xu Y, et al. Genetic polymorphisms and clopidogrel efficacy for acute ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Circulation. 2017 Jan 3;135(1):21–33.
  • Alakbarzade V, Huang X, Ster IC, et al. High on-clopidogrel platelet reactivity in ischaemic stroke or transient ischaemic attack: systematic review and meta-analysis. J Stroke Cerebrovasc. 2020 Jul 1;29(7):104877.
  • Zhao K, Yang M, Lu Y, et al. P2Y12 polymorphisms and the risk of adverse clinical events in patients treated with clopidogrel: a meta-analysis. Drug Res (Stuttg). 2019 Jan;69(1):23–31. doi: 10.1055/a-0622-8110
  • Fricke-Galindo I, Céspedes-Garro C, Rodrigues-Soares F, et al. Interethnic variation of CYP2C19 alleles, ‘predicted’ phenotypes and ‘measured’ metabolic phenotypes across world populations. Pharmacogenomics J. 2016 Apr;16(2):113–123. doi: 10.1038/tpj.2015.70
  • Koopmans AB, Braakman MH, Vinkers DJ, et al. Meta-analysis of probability estimates of worldwide variation of CYP2D6 and CYP2C19. Transl Psychiatry. 2021 Feb 24;11(1):141.
  • Zhou Y, Lauschke VM. The genetic landscape of major drug metabolizing cytochrome P450 genes—an updated analysis of population-scale sequencing data. Pharmacogenomics J. 2022 Dec;22(5–6):284–293. doi: 10.1038/s41397-022-00288-2
  • Nguyen T, Jean G, Pharand C. Resistance to clopidogrel: a review of the evidence. J Am Coll Cardiol. 2005;45(8):1157–1164. doi: 10.1016/j.jacc.2005.01.034
  • Kitazono T, Ikeda Y, Nishikawa M, et al. Influence of cytochrome P450 polymorphisms on the antiplatelet effects of prasugrel in patients with non-cardioembolic stroke previously treated with clopidogrel. J Thromb Thrombolysis. 2018 Nov;46(4):488–495. doi: 10.1007/s11239-018-1714-2
  • Mega JL, Close SL, Wiviott SD, et al. Genetic variants in ABCB1 and CYP2C19 and cardiovascular outcomes after treatment with clopidogrel and prasugrel in the TRITON–TIMI 38 trial: a pharmacogenetic analysis. Lancet. 2010 Oct 16;376(9749):1312–1319.
  • Cuisset T, Loosveld M, Morange PE, et al. CYP2C19* 2 and* 17 alleles have a significant impact on platelet response and bleeding risk in patients treated with prasugrel after acute coronary syndrome. JACC- Cardiovasc Inte. 2012 Dec;5(12):1280–1287. doi: 10.1016/j.jcin.2012.07.015
  • O’connor CT, Kiernan TJ, Yan BP. The genetic basis of antiplatelet and anticoagulant therapy: A pharmacogenetic review of newer antiplatelets (clopidogrel, prasugrel and ticagrelor) and anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban). Expert Opin Drug Met. 2017 Jul 3;13(7):725–739.
  • Li M, Hu Y, Wen Z, et al. Association of PEAR1 rs12041331 polymorphism and pharmacodynamics of ticagrelor in healthy Chinese volunteers. Xenobiotica. 2017 Dec 2;47(12):1130–1138.
  • Wallentin L, James S, Storey RF, et al. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: a genetic substudy of the PLATO trial. Lancet. 2010 Oct 16;376(9749):1320–1328.
  • Varenhorst C, Eriksson N, Johansson AA, et al. Effect of genetic variations on ticagrelor plasma levels and clinical outcomes. Eur Heart J. 2015 Aug 1;36(29):1901–1912.
  • Xie Q, Xiang Q, Liu Z, et al. Effect of CYP2C19 genetic polymorphism on the pharmacodynamics and clinical outcomes for patients treated with ticagrelor: a systematic review with qualitative and quantitative meta-analysis. BMC Cardiovasc Disor. 2022 Dec;22(1):1–1. doi: 10.1186/s12872-022-02547-3
  • De Luca G. Glycoprotein IIb‐IIIa inhibitors. Cardiovasc Ther. 2012 Oct;30(5):e242–54. doi: 10.1111/j.1755-5922.2011.00293.x
  • Shields DC, Fitzgerald AP, O’Neill PA, et al. The contribution of genetic factors to thrombotic and bleeding outcomes in coronary patients randomised to IIb/IIIa antagonists. Pharmacogenomics J. 2002 Mar;2(3):182–190. doi: 10.1038/sj.tpj.6500100
  • O’Connor FF, Shields DC, Fitzgerald A, et al. Genetic variation in glycoprotein IIb/IIIa (GPIIb/IIIa) as a determinant of the responses to an oral GPIIb/IIIa antagonist in patients with unstable coronary syndromes. Blood. 2001 Dec 1;98(12):3256–3260.
  • FitzGerald GA, Wood AJJ, FitzGerald GA. Dipyridamole. N Engl J Med. 1987 May 14;316(20):1247–1257.
  • Kim HH, Liao JK. Translational therapeutics of dipyridamole. Arterioscl Throm Vas. 2008 Mar 1;28(3):s39–42.
  • Kherallah RY, Khawaja M, Olson M, et al. Cilostazol: a review of basic mechanisms and clinical uses. Cardiovasc Drug Ther. 2021 Apr;16:1–6.
  • Hiratsuka M, Hinai Y, Sasaki T, et al. Characterization of human cytochrome p450 enzymes involved in the metabolism of cilostazol. Drug Metab Dispos. 2007 Oct 1;35(10):1730–1732.
  • Abbas R, Chow CP, Browder NJ, et al. In vitro metabolism and interaction of cilostazol with human hepatic cytochrome P450 isoforms. Hum Exp Toxicol. 2000 Mar;19(3):178–184. doi: 10.1191/096032700678827717
  • Yoo HD, Park SA, Cho HY, et al. Influence of CYP3A and CYP2C19 genetic polymorphisms on the pharmacokinetics of cilostazol in healthy subjects. Clin Pharmacol Ther. 2009 Sep;86(3):281–284. doi: 10.1038/clpt.2009.90
  • Yokoyama T, Yamauchi S, Yamagata K, et al. Impact of cilostazol pharmacokinetics on the development of cardiovascular side effects in patients with cerebral infarction. Biol Pharm Bull. 2021 Nov 1;44(11):1767–1774.
  • Yoo HD, Cho HY, Lee YB. Population pharmacokinetic analysis of cilostazol in healthy subjects with genetic polymorphisms of CYP3A5, CYP2C19 and ABCB1. Brit J Clin Pharmaco. 2010 Jan;69(1):27–37. doi: 10.1111/j.1365-2125.2009.03558.x
  • Maruyama H, Fukuoka T, Deguchi I, et al. Dual antiplatelet therapy clopidogrel with low-dose cilostazol intensifies platelet inhibition in patients with ischemic stroke. Internal Med. 2013;52(10):1043–1047. doi: 10.2169/internalmedicine.52.9550
  • Nakagawa I, Wada T, Park HS, et al. Platelet inhibition by adjunctive cilostazol suppresses the frequency of cerebral ischemic lesions after carotid artery stenting in patients with carotid artery stenosis. J Vasc Surg. 2014 Mar 1;59(3):761–767.
  • Hwang G, Huh W, Lee JS, et al. Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high on-treatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: a randomized clinical trial. JAMA Neurol. 2015 Jul 1;72(7):764–772.
  • Tajima H, Izumi T, Miyachi S, et al. Association between CYP2C19 genotype and the additional effect of cilostazol to clopidogrel resistance in neuroendovascular therapy. Nagoya J Med Sci. 2018 May;80(2):207. doi: 10.18999/nagjms.80.2.207
  • Xie HG, Wood AJ, Kim RB, et al. Genetic variability in CYP3A5 and its possible consequences. Pharmacogenomics. 2004 Apr 1;5(3):243–272.
  • Kurose K, Sugiyama E, Saito Y. Population differences in major functional polymorphisms of pharmacokinetics/pharmacodynamics-related genes in Eastern Asians and Europeans: implications in the clinical trials for novel drug development. Drug Metab Pharmacok. 2012;27(1):9–54. doi: 10.2133/dmpk.DMPK-11-RV-111
  • Wilterdink JL, Easton JD. Dipyridamole plus aspirin in cerebrovascular disease. Arch Neurol. 1999 Sep 1;56(9):1087–1092.
  • Lenz TL, Wilson AF. Clinical pharmacokinetics of antiplatelet agents used in the secondary prevention of stroke. Clin Pharmacokinet. 2003 Aug;42(10):909–920. doi: 10.2165/00003088-200342100-00003
  • Hartl DL, Clark AG, Clark AG. Principles of population genetics. Sunderland: Sinauer associates; 1997 Jan.
  • Floyd CN, Ferro A. Mechanisms of aspirin resistance. Pharmacol Therapeut. 2014 Jan 1;141(1):69–78.
  • Kuliczkowski W, Witkowski A, Polonski L, et al. Interindividual variability in the response to oral antiplatelet drugs: a position paper of the working group on antiplatelet drugs resistance appointed by the section of cardiovascular interventions of the polish cardiac society, endorsed by the working group on thrombosis of the European society of cardiology. Eur Heart J. 2009 Feb 1;30(4):426–435.
  • Kweon OJ, Lim YK, Kim B, et al. Effectiveness of platelet function analyzer-100 for laboratory detection of anti-platelet drug-induced platelet dysfunction. Ann Lab Med. 2019 Jan;39(1):23–30. doi: 10.3343/alm.2019.39.1.23
  • Krishnan K, Nguyen T, Appleton J, et al. Antiplatelet resistance: a review of concepts, mechanisms, and implications for management in acute ischemic stroke and transient ischemic attack. Stroke Vasc Interv Neurol. 2023;3(3):e000576. doi: 10.1161/SVIN.122.000576
  • Lordkipanidzé M, Pharand C, Schampaert E, et al. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J. 2007 Jul 1;28(14):1702–1708. doi: 10.1093/eurheartj/ehm226
  • Linnemann B, Schwonberg J, Rechner AR, et al. Assessment of clopidogrel non-response by the PFA-100® system using the new test cartridge INNOVANCE® PFA P2Y. Ann Hematol. 2010 Jun;89(6):597–605. doi: 10.1007/s00277-009-0881-9
  • Harrison P, Segal H, Blasbery K, et al. Screening for aspirin responsiveness after transient ischemic attack and stroke: comparison of 2 point-of-care platelet function tests with optical aggregometry. Stroke. 2005 May 1;36(5):1001–1005.
  • Diener HC, Cunha L, Forbes CE, et al. European stroke prevention study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996 Nov 1;143(1–2):1–3.
  • Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004 Jul 24;364(9431):331–337.
  • Bhatt DL, Fox KA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006 Apr 20;354(16):1706–1717.
  • Halkes PH, Van Gijn J, Kappelle LJ, et al. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006 May 1;367(9523):1665–1673.
  • Sacco RL, Diener HC, Yusuf S, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008 Sep 18;359(12):1238–1251.
  • Investigators S, Benavente OR, Hart RG, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012 Aug;367(9):817–825.
  • Bath PM, Woodhouse LJ, Appleton JP, et al. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018 Mar 3;391(10123):850–859.
  • Johnston SC, Amarenco P, Denison H, et al. Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med. 2020 Jul 16;383(3):207–217.
  • Kwon SU, Hong KS, Kang DW, et al. Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis. Stroke. 2011 Oct;42(10):2883–2890. doi: 10.1161/STROKEAHA.110.609370
  • Uchiyama S, Sakai N, Toi S, et al. Final results of cilostazol-aspirin therapy against recurrent stroke with intracranial artery stenosis (CATHARSIS). Cerebrovasc Dis Extra. 2015;5(1):1–3. doi: 10.1159/000369610
  • Yusuf S. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation (vol 345, pg 494, 2001). N Engl J Med. 2001 Dec 6;345(23):1716–.
  • Johnston SC, Elm JJ, Easton JD, et al. Time course for benefit and risk of clopidogrel and aspirin after acute transient ischemic attack and minor ischemic stroke: a secondary analysis from the POINT randomized trial. Circulation. 2019 Aug 20;140(8):658–664.
  • Grotta JC. Antiplatelet therapy after ischemic stroke or TIA. N Engl J Med. 2018 Jul 19;379(3):291–292.
  • Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011 Sep 15;365(11):993–1003.
  • Trifan G, Gorelick PB, Testai FD. Efficacy and safety of using dual versus monotherapy antiplatelet agents in secondary stroke prevention: systematic review and meta-analysis of randomized controlled clinical trials. Circulation. 2021 Jun 22;143(25):2441–2453.
  • Wang Y, Zhao X, Lin J, et al. Association between CYP2C19 loss-of-function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack. JAMA. 2016 Jul 5;316(1):70–78.
  • Wang Y, Meng X, Wang A, et al. Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA. N Engl J Med. 2021 Dec 30;385(27):2520–2530.
  • Pan Y, Meng X, Jin A, et al. Time course for benefit and risk with ticagrelor and aspirin in individuals with acute ischemic stroke or transient ischemic attack who carry CYP2C19 loss-of-function alleles: a secondary analysis of the CHANCE-2 randomized clinical trial. JAMA Neurol. 2022 Aug 1;79(8):739–745.
  • Liu H, Jing J, Wang A, et al. Genotype-guided dual antiplatelet therapy in minor stroke or transient ischemic attack with a single small subcortical infarction. Neurology. 2023 Jan 25;100(16):e1643–e1654.
  • Zhang X, Jiang S, Xue J, et al. Personalized antiplatelet therapy guided by clopidogrel pharmacogenomics in acute ischemic stroke and transient ischemic attack: A prospective, randomized controlled trial. Front Pharmacol. 2022;13. doi: 10.3389/fphar.2022.931405
  • CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329–1339. doi: 10.1016/S0140-6736(96)09457-3
  • Dawson J, Bejot Y, Christensen L, et al. European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack. Eur Stroke J. 2022;7(3):I–XLI. doi: 10.1177/23969873221100032
  • Micieli A, Singh N, Jahn B, et al. Cost-effectiveness of testing for CYP2C19 loss-of-function carriers following transient ischemic attack/minor stroke: A Canadian perspective. Int J Stroke. 2023 Apr;18(4):416–425. doi: 10.1177/17474930221111898
  • Paraskevas KI, Gloviczki P, Mikhailidis DP, et al. Optimal periprocedural antithrombotic treatment in carotid interventions: an international, multispecialty, expert review and position statement. Prog Cardiovasc Dis. 2022 Oct 18;74:28–37.
  • Collette SL, Bokkers RP, Dierckx RA, et al. Clinical importance of testing for clopidogrel resistance in patients undergoing carotid artery stenting—A systematic review. Ann Transl Med. 2021 Jul;9(14):1211–1211. doi: 10.21037/atm-20-7153
  • Song TJ, Suh SH, Min PK, et al. The influence of anti-platelet resistance on the development of cerebral ischemic lesion after carotid artery stenting. Yonsei Med J. 2013 Mar 1;54(2):288–294.
  • Sorkin GC, Dumont TM, Wach MM, et al. Carotid artery stenting outcomes: do they correlate with antiplatelet response assays? J Neurointerv Surg. 2014 Jun 1;6(5):373–378.
  • Zhu WY, Zhao T, Xiong XY, et al. Association of CYP2C19 polymorphisms with the clinical efficacy of clopidogrel therapy in patients undergoing carotid artery stenting in Asia. Sci Rep. 2016 May 3;6(1):1–7.

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