The Dynamic Effect of Non-cytochrome P450 Isoenzyme 3A4（CYP3A4）-Metabolized and Cytochrome P450 Isoenzyme 3A4（CYP3A4）-Metabolized Statins on Clopidogrel Resistance in Patients With Cerebral Infarction

Study Overview
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Brief Summary
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The investigators team had found that the presence of dynamic changes of Clopidogrel resistance are not associated with genetic factors. Currently, study on moderate doses of statins and dynamic Clopidogrel resistance has not been reported, therefore this study will observe 160 cases of open prospective secondary prevention in patients with cerebral infarction. Excluded: those patients occurs Clopidogrel resistance because of slow metabolism caused by cytochrome P450 isoenzyme 2C19（CYP2C19, and then observed the impact of the cytochrome P450 isoenzyme 3A4 （CYP3A4）-metabolized and non-cytochrome P450 isoenzyme 3A4 （CYP3A4）-metabolized statins dynamically on Clopidogrel resistance in the next 9 months, adverse events will be recorded, the metabolite of clopidogrel（H4 ）and the polymorphism of cytochrome P450 isoenzyme 2C19 （CYP2C19）/cytochrome P450 isoenzyme 3A4 （CYP3A4）/ cytochrome P450 isoenzyme 2C9（CYP2C9）will be detected. Expected Result: the patients use the cytochrome P450 isoenzyme 3A4（CYP3A4）-metabolized statins will result in dynamic Clopidogrel resistance easily ,H4 levels will decline, and Clopidogrel resistance is not related to the polymorphism of cytochrome P450 isoenzyme 3A4 （CYP3A4）.

Conditions
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Cerebral Infarction, Clopidogrel,Poor Metabolism of (Disorder)

Intervention / Treatment
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* Drug: atorvastatin and clopidogrel
* Drug: rosuvastatin and clopidogrel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The patient must have signed an informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study. Age <85 years and >45 years ,Male or female. The patient have been Cerebral infarction for one month. national institutes of health stroke scale（NIHSS）score ≤23 points. Blood Platelet count greater than 150×10^9／L,and Less than 500×10^9／L. The patient never do not taking aspirin 、dipyridamole、clopidogrel,or the patient had been taken these anti-platelet drugs but has been discontinued for two weeks at least. The patient never do not taking Statins or the patient have been stop taking statins 2 weeks for two weeks. Exclusion Criteria: Allergic constitution , or allergic to the composition of the drugs in this study. national institutes of health stroke scale（NIHSS） score >23 points. Atrial fibrillation and other cardiogenic cerebral embolism. Patients who were undergone surgery and trauma (including fractures) within the past three month. Patients with known dysfunction of vital organs or suffered from Serious cardiovascular disease ，or coagulation disorders. The patient took Proton pump inhibitors recently. The history of data collection and the follow-up process can not be saved.

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: atorvastatin and Clopidogrel<br>80 patients will be taking atorvastatin 40mg/d plus clopidogrel 75mg/d for 9 months。 | Drug: atorvastatin and clopidogrel<br>* Dose: atorvastatin 40mg/d plus clopidogrel 75mg/d for 9 months.<br>|
| Experimental: rosuvastatin and Clopidogrel<br>80 patients will be taking rosuvastatin 20mg/d plus clopidogrel 75mg/d for 9 months。 | Drug: rosuvastatin and clopidogrel<br>* Dose: rosuvastatin 20mg/d plus clopidogrel 75mg/d for 9 months.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| incidence of clopidogrel resistance | Definition of clopidogrel resistance is the absolute change of 5 microliter adenosine diphosphate(ADP) induced PAR≤10% as compared to baseline. So, incidence of clopidogrel resistance= (PAR at monitor point - PAR at baseline) / PAR at baseline×100 %≤10 %。 Measures of PAR: PAR is measured by Light transmittance aggregometry (LTA) and according to the standard of Rev。 | For nine months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Clopidogrel-drug interactions