PRUs Track CYP2C19 Genotype but Not Stroke Recurrence

This small prospective study evaluates whether P2Y12 reaction units can serve as an accessible surrogate for CYP2C19 genotype when guiding clopidogrel-based dual antiplatelet therapy after minor stroke.

clopidogrelaspirinticagrelorP2Y12 inhibitorsCYP2C19pharmacogeneticsVerifyNowP2Y12 reaction unitsacute ischemic stroketransient ischemic attackdual antiplatelet therapysecondary stroke preventionABCD-GENEobservational study Neurology / Neuropharmacology

Background Information

PRUs may identify clopidogrel resistance in stroke patients without genotyping.

Understanding the differences in clopidogrel response based on CYP2C19 genotype can guide more effective secondary prevention strategies for stroke. CYP2C19 loss-of-function (LOF) carriers had significantly higher P2Y12 reaction units (PRUs) (265 vs. 161; p < 0.01), indicating higher clopidogrel resistance. PRUs may serve as a practical marker for identifying clopidogrel resistance when CYP2C19 genotyping is not available, although they were not linked to short-term clinical outcomes in this study. PRUs reflect clopidogrel resistance in CYP2C19 LOF carriers and could serve as a marker when genotyping is inaccessible.

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Authors: Stone RM, Smith A, Gunter S, Weko AT, Gottschalk C, Lee C, Ramsey A, Weatherspoon MP, Worrall BB

Citation: Stone RM, Smith A, Gunter S, et al. Association Between CYP2C19 Genotype and P2Y12 Reaction Units in Patients Receiving Clopidogrel After Acute Ischemic Stroke: A Prospective, Observational Study. Pharmacotherapy. 2026;46(10):e70201. doi:10.1002/phar.70201

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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