Objective To compare the therapeutic effects of individualized medication based on clopidogrel and aspirin gene testing in patients with non-cardioembolic ischemic stroke or transient ischemic attack (TIA).

Methods A total of 430 patients with non-cardioembolic ischemic stroke or TIA were enrolled. Patients were divided into a conventional treatment group (control group) and an individualized medication group based on medical records review. The control group received aspirin combined with clopidogrel for 21 days within 24 hours of onset, followed by long-term treatment with aspirin (75–150 mg/day) or clopidogrel (75 mg/day) alone. The individualized medication group was treated based on the results of clopidogrel and aspirin gene testing. The neurological function at admission and discharge, disability function at admission and 90 days after discharge, as well as ischemic and hemorrhagic events at 90 days after discharge, were compared between the two groups.

Results There was no significant difference in neurological function scores between the two groups at admission and discharge (P ＞ 0.05). However, there was a significant difference in disability function scores between the two groups at 90 days after discharge (P ＜ 0.05). The incidence of stroke recurrence, re-admission, and hemorrhagic events at 90 days after discharge was lower in the individualized medication group than in the control group (P ＜ 0.05 and P ＜ 0.01, respectively).

Conclusions Medication based on clopidogrel and aspirin gene testing can significantly reduce the incidence of adverse events in patients with non-cardioembolic ischemic stroke or TIA, while improving patient prognosis.