{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:53:40Z","timestamp":1791356020529,"version":"4.3.1"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Carriers of CYP2C19 loss\u2010of\u2010function alleles (LoFA) exhibit reduced metabolism of clopidogrel, potentially compromising the efficacy of dual antiplatelet therapy (DAPT) in acute ischemic stroke. We aimed to distinguish the impact of initial antiplatelet regimens from the discharge deescalation on functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">The retrospective cohort study linked the prospective stroke registry with the Taiwan Precision Medicine Initiative biobank. Patients with mild to moderate acute ischemic stroke (National Institutes of Health Stroke Scale score \u226410) were included. Favorable outcomes (modified Rankin Scale score \u22641) of 2 windows were analyzed: (1) the acute window (\u226448 hours), assessing outcomes at discharge, and (2) the deescalation window (discharge), assessing outcomes at 90\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 741 patients, 463 (62.5%) were LoFA carriers. In the acute window, genotype was not associated with favorable outcomes; clinical severity (age, initial National Institutes of Health Stroke Scale score) was the dominant predictor. However, in the deescalation window, in the overall cohort, DAPT with aspirin and clopidogrel at discharge was independently associated with favorable outcomes at 90\u2009days (odds ratio [OR], 2.34 [95% CI, 1.16\u20134.74];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.018). Stratified analysis revealed that this benefit was driven primarily by LoFA carriers, in whom DAPT with aspirin and clopidogrel at discharge was independently associated with favorable outcomes (OR, 2.74 [95% CI, 1.17\u20136.38];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.020). However, this association was attenuated in propensity score\u2010matched analyses, and there was no interaction between CYP2C19 LoFA carrier status and DAPT with aspirin and clopidogrel on favorable outcomes at 90\u2009days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">CYP2C19 genotype did not predict early neurological deterioration. The potential long\u2010term clinical benefit of maintaining DAPT with aspirin and clopidogrel at discharge for LoFA carriers requires confirmation in adequately powered randomized trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.049319","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:17:39Z","timestamp":1790680659000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Dual Antiplatelet Therapy in Acute Ischemic Stroke: A 2\u2010Time\u2010Window Study of CYP2C19 Genotypes and Functional Outcomes"],"prefix":"10.1161","volume":"15","author":[{"given":"Yu\u2010Hsuan","family":"Wu","sequence":"first","affiliation":[{"name":"Taichung Veterans General Hospital","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0842-9875","authenticated-orcid":false,"given":"Chi\u2010Sheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Taichung Veterans General Hospital","place":["Taichung, Taiwan"]},{"name":"National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0492-8104","authenticated-orcid":false,"given":"Kuo\u2010Cheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Taichung Veterans General Hospital","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7254-0108","authenticated-orcid":false,"given":"Po\u2010Lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Taichung Veterans General Hospital","place":["Taichung, Taiwan"]},{"name":"National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]},{"name":"National Chung Hsing University","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.26867"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215340"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800410"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211027006"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2024.0146"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2309137"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.0000000000001972"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.028713"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/cts.13792"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.02.031"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/17512433.2022.2108401"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148891"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.8662"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.12443"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.05.013"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.2526"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001257"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111749"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-023-00901-2"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","unstructured":"Yang H\u2010C Kwok P\u2010Y Li L\u2010H Liu Y\u2010M Jong Y\u2010J Lee K\u2010Y Wang D\u2010W Tsai M\u2010F Yang J\u2010H Chen C\u2010H et\u00a0al. 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