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This study aimed to perform an updated meta\u2010analysis to assess the association between <jats:italic>CYP2C19<\/jats:italic> LoF alleles and the risk of recurrent stroke in patients taking clopidogrel. Databases were searched for the literature on eligible studies. The end points were recurrent stroke, composite vascular events, and bleeding events. Odds ratios (ORs) were calculated using RevMan software, where <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 was considered statistically significant. Patients carrying <jats:italic>CYP2C19<\/jats:italic> LoF alleles who were treated with clopidogrel had a significantly increased risk of recurrent ischemic stroke compared with non\u2010carriers (OR 2.18, 96% CI 1.80\u20132.63; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.00001). The risk of recurrent stroke was only significantly different in Asian patients (OR 2.29, 96% CI 1.88\u20132.80; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.00001) but not in patients of other ethnicities; however, there were a limited number of studies in other ethnic groups. Both observational studies (OR 2.83, 96% CI 2.20\u20133.65; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.00001) and RCTs (OR 1.48, 96% CI 1.10\u20131.98; <jats:italic>p<\/jats:italic>\u2009=\u20090.009) found associations with a significantly increased risk of recurrent ischemic stroke. Asian stroke patients or TIA patients carrying <jats:italic>CYP2C19<\/jats:italic> LoF alleles and taking clopidogrel were at a significantly higher risk of recurrent ischemic stroke than non\u2010carriers. Significantly increased risk of recurrent ischemic stroke was found in both observational studies and RCTs.<\/jats:p>","DOI":"10.1111\/cts.13792","type":"journal-article","created":{"date-parts":[[2024,4,6]],"date-time":"2024-04-06T04:58:47Z","timestamp":1712379527000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["The association of <i>CYP2C19<\/i><scp>LoF<\/scp> alleles with adverse clinical outcomes in stroke patients taking clopidogrel: An updated <scp>meta\u2010analysis<\/scp>"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1432-7701","authenticated-orcid":false,"given":"Mohitosh","family":"Biswas","sequence":"first","affiliation":[{"name":"Department of Pharmacy University of Rajshahi  Rajshahi Bangladesh"},{"name":"Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital Mahidol University  Bangkok Thailand"},{"name":"Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. 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