For patients with minor stroke or transient ischemic attack (TIA) who carry the CYP2C19 loss-of-function allele, those with obesity receive more clinical benefit from ticagrelor-acetylsalicylic acid (ASA) than clopidogrel-ASA, according to a study published in CMAJ. Researchers conducted a randomized, double-blind trial involving patients with minor stroke or TIA who carried the CYP2C19 loss-of-function allele (n=6,412). Participants were randomly assigned to receive ticagrelor-ASA or clopidogrel- ASA. Among patients with obesity (N=876), ticagrelor-ASA was associated with a significantly lower rate of stroke within 90 days compared with clopidogrel-ASA (5.4% vs 11.3%; HR, 0.51; 95% CI, 0.30-0.87), but not among those without obesity (n=5,536; 6.0% vs 7.0%; HR, 0.84; 95% CI, 0.69-1.04). No differences were seen in the rates of severe or moderate bleeding by BMI group.
