Precision medicine as a predictive factor for risk of hospitalization of recurrent ischemic stroke patients treated with low dose aspirin. A pilot study

Recurrent ischemic stroke risk after transient ischemic attack was underestimated by most of epidemiological studies due to the widespread use of very different and sometimes restrictive definitions for recurrent stroke instead of a standard definition, making it difficult to assess the benefit of early prevention of recurrence. Knowing that early intervention by treatment with aspirin reduced fatal recurrent stroke and proved to be cost effective by reducing hospital admission, it was worthwhile studying the pharmacogenetics association as well as biological risk factors of aspirin intolerance for patients with recurrent ischemic stroke. Accordingly, our primary outcome was to investigate the association of CYP2C9*3 (Rs1057910) polymorphism as well as other factors such as diabetes, hypertension and smoking with aspirin intolerance for these patients. The secondary outcome was to study the correlation between TNF-alpha as an inflammatory mediator and the prognosis of ischemic stroke for these patients. Our results showed that although smoking and heterozygous A/C of Rs1057910 still have a higher prevalence however statistically insignificant risk for ischemic stroke recurrence compared with other risk factors; OR1.69 and 1.9, 95%CI (0.471-1.695) and (0.321-11.257) respectively. Also, our results suggest that there is a borderline statistically significant correlation between recurrent stroke prognosis and TNF alpha (p = 0.043). Conclusion: This study failed to detect association of Rs1057910 variant of CYP2C9 gene with preventive aspirin for patients with ischemic stroke. However, a somehow significant association was detected between ischemic stroke prognosis and TNF- alpha as an inflammatory marker. Further research investigations on larger sample size population are encouraged.

Automated summary

Most epidemiological studies have underestimated the risk of recurrent ischemic stroke after transient ischemic attack due to the lack of a standard definition for recurrent stroke. This study aimed to investigate the association of CYP2C9*3 (Rs1057910) polymorphism and other risk factors with aspirin intolerance in patients with recurrent ischemic stroke. The results showed that smoking and the heterozygous A/C of Rs1057910 had a higher prevalence but statistically insignificant risk for stroke recurrence compared to other risk factors. There was a borderline statistically significant correlation between stroke prognosis and TNF-alpha as an inflammatory mediator. Further research on a larger sample size population is recommended.