Impact of Cyp2c19 Allele 17 Mutase on Clopidogrel Hyper-Responsiveness in Indonesian Patients with Ischemic Stroke

BACKGROUND: Ischemic stroke dominated up to 76% of the 101.5 million stroke cases globally. One of the treatments for stroke is secondary prevention by administering antiplatelet. Clopidogrel is an add-on antiplatelet to the dual antiplatelet therapy (DAPT) regimen. In its metabolism, clopidogrel can show the nature of resistance and bleeding risk. Studies on resistance have been widely put forward but not with the bleeding. The study of the bleeding risk to Asian races focused only on East Asian races. AIM: The objective of the study is to determine the bleeding risk in the Indonesian population and the correlation with the polymorphism of CYP2C19 allele 17. METHODS: There were 112 participants in this study. About 45.5% showed a normal response to clopidogrel, but 40.2% had a bleeding risk. All participants (100.0%) had mutations in CYP2C19 allele 17, with 47.3% being intermediate metabolizers. RESULTS: The bleeding risk was significantly correlated with clopidogrel (p: 0.02). The Indonesian population has a high bleeding risk from the clopidogrel administration. CONCLUSION: Compared to DAPT administration, clopidogrel can be a monotherapy for secondary stroke prevention.