Role of Cytochrome p450 in Clopidogrel Resistance in Indonesian Stroke Patients


  • Rakhmad Hidayat Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Department of Neurology, Universitas Indonesia Hospital, Jakarta, Indonesia
  • Al Rasyid Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Salim Harris Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Department of Neurology, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Alida R. Harahap Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Herqutanto Herqutanto Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Melva Louisa Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Erlin Listyaningsih Department of Biomedical Laboratory, Harapan Kita Hospital, Jakarta, Indonesia
  • Aldy Safruddin Rambe Department of Neurology, Universitas Sumatera Utara, Medan, Indonesia
  • Tonny Loho Department of Clinical pathology, Faculty of Medicine and Health Science, Kristen Krida Wacana University, West Jakarta, Indonesia



antiplatelet, clopidogrel resistance, CYP450, CYP2C19, stroke


BACKGROUND: Stroke is the second leading cause of death in the world. Clopidogrel is one of the recommended therapies for it. Disturbances in the metabolic stages of clopidogrel, such as dysregulation of cytochrome p450 (CYP450) and cytochrome P450 2C19 (CYP2C19), can cause unresponsiveness or resistance. However, studies on clopidogrel resistance related to CYP450 and CYP2C19 in Indonesia are limited.

METHODS: This cross-sectional study was conducted in two hospitals over a 1-year period. All patients had a minimum of one episode of ischemic stroke. Data on demographics, clopidogrel resistance, CYP450 concentration, and CYP2C19 polymorphism were collected. In total, 112 participants were enrolled in this study.

RESULTS: We found that the incidence of clopidogrel resistance was 14.3% and the bleeding risk was high (40.3 %). The number of mutations in the CYP2C19 allele *17 was 96.0%. We also found that sex, hemoglobin, and CYP450 were significantly correlated with clopidogrel resistance, and with hemoglobin and CYP450 as independent factors. Fasting blood glucose and CYP2C19 allele *3 were independent factors for CYP450.

CONCLUSION: The incidence of clopidogrel resistance in the Indonesian population is low; therefore, it is not an urgent issue. An important issue in this population is the high risk for bleeding. Patient treatment should be adjusted by considering this risk.


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How to Cite

Hidayat R, Rasyid A, Harris S, Harahap AR, Herqutanto H, Louisa M, Listyaningsih E, Rambe AS, Loho T. Role of Cytochrome p450 in Clopidogrel Resistance in Indonesian Stroke Patients. Open Access Maced J Med Sci [Internet]. 2023 May 23 [cited 2024 Apr. 23];11(B):555-61. Available from:

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