Genetic resistance to antiplatelet agents and delayed stroke development in vertebral artery dissection: a clinical case
K. A. Popugaev,
A. M. Kvasnikov,
O. V. Karpova,
A. A. Sysoeva,
N. M. Kruglyakov,
D. S. Markhulia,
O. K. Popugaeva https://doi.org/10.37489/2588-0527-2025-2-46-52
EDN: JUZAMW
Abstract
A clinical case of a 35-year-old man with dissection of the left vertebral artery is presented, in connection with which dual antiplatelet therapy in the form of aspirin and clopidogrel, as well as anticoagulant therapy with enoxaparin, was prescribed to prevent the development of thromboembolic complications.
On day 5, the patient developed numbness in the right extremities, dysphagia and dysarthria, increased ataxia, left-sided ptosis, right-sided hemiparesis and hemihypesthesia. A control MRI scan of the brain revealed a focus of ischemia in the medulla oblongata. Pharmacogenetic testing was performed with the study of genetic resistance to antiplatelet drugs with the determination of polymorphic variants rs4244285*2, rs4986893*3, rs12248560*17 of the CYP2C19 gene. It was revealed that the patient was a carrier of the CT genotype according to the rs12248560 polymorphic variant, the GA genotype according to the rs4244285 polymorphic variant, and the GG genotype according to the rs4986893 polymorphic variant of the CYP2C19 gene. This corresponds to a variant of an intermediate metabolizer with an indistinctly defined effect of clopidogrel. The above clinical observation with the development of delayed ischemic stroke after spinal artery dissection (DPA) draws attention to the problem of genetic resistance to antiplatelet agents in this patient population. The development of delayed ischemic stroke in DPA is the basis for determining genetic resistance to antiplatelet agents and the subsequent possible change in treatment tactics.
About the Authors
K. A. Popugaev
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency
Russian Federation
Competing Interests:
Russian Federation
Konstantin A. Popugaev — PhD, Dr. Sci. (Med.), Corresponding Member of the Russian Academy of Sciences, Deputy Chief Physician for Anesthesiology and Intensive Care, Head of the Anesthesiology and Intensive Care Department No. 3, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency; Head of the Department of Anesthesiology, Resuscitation, and Intensive Care at the Medical and Biological University of Innovation and Continuing Education, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency.
Moscow
Competing Interests:
The authors declare no conflict of interest
A. M. Kvasnikov
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency
Russian Federation
Competing Interests:
Russian Federation
Artem M. Kvasnikov — PhD, Cand. Sci. (Med), the anesthesiologist-resuscitator; Assistant of the Department of Anesthesiology, Resuscitation, and Intensive Care at the Medical and Biological University of Innovation and Continuing Education, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency.
Moscow
Competing Interests:
The authors declare no conflict of interest
O. V. Karpova
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency
Russian Federation
Competing Interests:
Russian Federation
Olga V. Karpova — PhD, Cand. Sci. (Med), Head of the Neurology Department for the treatment and rehabilitation of patients with stroke and CNS diseases, Assistant Professor of the Department of Neurology with courses in neurosurgery, preventive medicine, and health-saving technologies, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency.
Moscow
Competing Interests:
The authors declare no conflict of interest
A. A. Sysoeva
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency
Russian Federation
Competing Interests:
Russian Federation
Anya A. Sysoeva — Resident of the Department of Anesthesiology, Resuscitation, and Intensive Care at the Medical and Biological University of Innovation and Continuing Education, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency.
Moscow
Competing Interests:
The authors declare no conflict of interest
N. M. Kruglyakov
State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency
Russian Federation
Competing Interests:
Russian Federation
Nikolay M. Kruglyakov — Head of Anesthesiology and Intensive Care Department No. 2, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency; Assistant of the Department of Anesthesiology, Resuscitation, and Intensive Care at the Medical and Biological University of Innovation and Continuing Education, State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Biological Agency.
Moscow
Competing Interests:
The authors declare no conflict of interest
D. S. Markhulia
Sklifosovsky Research Institute for Emergency Medicine
Russian Federation
Competing Interests:
Russian Federation
Dina S. Markhulia — PhD, Cand. Sci. (Med), anesthesiologistresuscitator at the intensive care unit for cardiac surgery patients, Sklifosovsky Institute.
Moscow
Competing Interests:
The authors declare no conflict of interest
O. K. Popugaeva
I. M. Sechenov First Moscow State Medical University
Russian Federation
Competing Interests:
Russian Federation
Olga K. Popugaeva — 4th-year student of the Faculty of Pediatrics, I. M. Sechenov First Moscow State Medical University.
Moscow
Competing Interests:
The authors declare no conflict of interest
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For citations:
Popugaev K.A., Kvasnikov A.M., Karpova O.V., Sysoeva A.A., Kruglyakov N.M., Markhulia D.S., Popugaeva O.K. Genetic resistance to antiplatelet agents and delayed stroke development in vertebral artery dissection: a clinical case. Pharmacogenetics and Pharmacogenomics. 2025;(2):46-52. (In Russ.) https://doi.org/10.37489/2588-0527-2025-2-46-52. EDN: JUZAMW
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