To investigate the value of CYP2C19 gene polymorphism combined with thromboelastogram (TEG) -guided antiplatelet therapy for non-disabling ischemic cerebrovascular events (NICE) with large artery atherosclerosis.

A total of 150 patients with initial NICE in Department of Neurology in Luoyang Central Hospital Affiliated to Zhengzhou University from March 2020 to September 2021 were randomly divided into the observation group (75 cases) and the control group (75 cases). The observation group received different doses of dual antiplatelet therapy for 21 days according to CYP2C19 gene results, and effective drugs or new antiplatelet drugs were selected according to TEG results after 21 days (54 patients in Clopidogrel effective subgroup and 21 patients in Clopidogrel resistance subgroup). The control group received conventional dose of dual antiplatelet therapy, and was randomly selected for single antiplatelet therapy after 21 days. The recurrence of ischemic stroke and the occurrence of bleeding events were compared between the two groups.

The CYP2C19 genes and TEG tests in Clopidogrel effective and resistance subgroup of the observation group were observed and be significantly, respectively (Z=5.374, P＜0.001; Z=6.572, P＜0.001). The recurrence of stroke in the observation group (9.33%) was significantly lower than that in the control group (21.33%), and the difference between the two groups was statistically significant (P＜0.05). The incidence of bleeding events was 6.67% in the observation group and 5.33% in the control group, and there was no significant difference between the two groups (P＞0.05).

In the secondary prevention of non-disabling cerebral infarction with large artery atherosclerosis, anti-platelet drugs screened according to CYP2C19 gene polymorphism and the effect of antiplatelet therapy evaluated by TEG can effectively reduce the recurrence rate of stroke without increasing the risk of bleeding.