Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA stratified by age and renal function: CHANCE-2 trial substudy

作者：Yu Wu, Yilun Zhou, Yuesong Pan, Aoming Jin, Xia Meng, Hao Li, Yilong Wang, Yilong Wang, Yong Jiang, Yongjun Wang, Yongjun Wang · 发表于：Renal Failure · 年份：2025 · DOI：10.1080/0886022x.2025.2526684 · 被引用次数：3 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Diabetes Treatment and Management、Atrial Fibrillation Management and Outcomes

Objective To compare the efficacy and safety of ticagrelor versus clopidogrel in stroke patients who were CYP2C19 loss-of-function (LOF) carriers stratified by age and renal function.Methods Patients in the CHANCE-2 trial were randomized to ticagrelor-aspirin or clopidogrel–aspirin treatment. The primary efficacy outcome was occurrence of a new stroke within 90 days, while bleeding was assessed for safety. Patients were categorized based on age and estimated glomerular filtration rate (eGFR).Results In patients with eGFR >90 mL/min/1.73 m2, ticagrelor-aspirin was associated with a significantly lower risk of the subsequent stroke within 90 days compared with the clopidogrel-aspirin in those aged over 65 years (HR 0.53, 95% CI 0.33–0.85, p = 0.008) and under 65 years (HR, 0.67, 95% CI, 0.47–0.96, p = 0.03). While in those with eGFR 60–89 mL/min/1.73 m2, ticagrelor did not show superiority over clopidogrel in reducing stroke regardless of age category (age ≥ 65: HR 1.14, 95% CI 0.71–1.84, p = 0.59; age < 65: HR 0.40, 95% CI 0.12–1.33, p = 0.13). The incidence of mild bleeding events was higher with ticagrelor-aspirin treatment in those aged < 65 years with eGFR ≥90 mL/min/1.73 m2 (HR 3.33, 95% CI 2.18–5.10, p < 0.001) and in those aged ≥ 65 years with eGFR <60mL/min/1.73 m2 (HR 8.68, 95% CI 1.06–71.1, p = 0.04).Conclusions Elderly patients with normal renal function appear to benefit from ticagrelor compared with clopidogrel. Both younger patients with normal renal function and...