The Relationship between the Transcranial Doppler Pulsatility Changes and the CYP2C19 Genotype on Clopidogrel Treatment
오진영, 한지은, 김태민, 박중현, 백종삼, 김정연, 박재현, 한상원, 김응규,
소속 상세정보
오진영 ( Oh Jin-Young )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
한지은 ( Han Ji-Eun )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
김태민 ( Kim Tae-Min )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
박중현 ( Park Joong-Hyun )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
백종삼 ( Baik Jong-Sam )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
김정연 ( Kim Jeong-Yeon )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
박재현 ( Park Jae-Hyeon )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
한상원 ( Han Sang-Won )
Inje University College of Medicine Sanggye Paik Hospital Department of Neurology
김응규 ( Kim Eung-Gyu )
Inje University College of Medicine Busan Paik Hospital Department of Neurology
Abstract
Background: We hypothesized that cytochrome P450 2C19 (CYP2C19) polymorphisms in clopidogrel-treated patients would influence cerebral vessel viscosity, which was related to transcranial Doppler (TCD) pulsatility index (PI). Hence, we explored the relationship between the CYP2C19 genotype status and the TCD PI changes in acute ischemic stroke patients on clopidogrel treatment using serial TCD examinations.
Methods: Patients (aged ≥40 years) who developed ischemic stroke within 7 days of onset of symptom from June 2018 to May 2019 were recruited for this study. Patients with high-risk cardiac sources of emboli, or stroke of other determined etiology as a stroke subtype, were excluded from the study. TCD was performed 5 (±2) days and followed up 180 (±30) days after onset of stroke.
Results: Eighty-four patients were enrolled for this study. Patients were categorized into decreased and increased PI groups. Good genotype for clopidogrel metabolism was found in 38% of the decreased-PI patients and 25% of the increased-PI patients (p=0.252). CYP2C19 genotype status was not associated with PI changes in both groups. Hematocrit (Hct) was significantly related to PI changes.
Conclusion: CYP2C19 genotype status was not related to TCD PI changes in acute ischemic stroke patients on clopidogrel treatment. Hct was the major determinant factor of PI. The negative association of Hct with cerebral blood flow velocity and its positive association with blood viscosity are plausible explanations for this phenomenon.
키워드
Antithrombotics; Blood viscosity; Hematocrit; Stroke; Ultrasonography
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