Implementation of Routing CYP2C19 Pharmacogenetic Testing to Guide Antiplatelet Therapy Post-Percutaneous Coronary Intervention
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Publication Date
2025
Abstract
A P2Y12 inhibitor with aspirin is recommended in the post-PCI setting with stent implantation. Clopidogrel requires hepatic biotransformation to generate an active metabolite which inhibits platelet aggregation however the most prominent enzyme, CYP2C19, is a highly polymorphic gene that results in wide range of responses. Poor CYP2C19 function can lead to suboptimal clinical outcomes and increased thrombotic risk but despite this variability, clopidogrel is consistently used without routine testing. The process to be implemented is routine genetic testing in patients started on clopidogrel to optimize effectiveness and safety of their treatment while aligning with current clinical guidelines and best practices. A weekly review will be conducted to identify patients who were initiated on clopidogrel therapy. Eligible patients will be scheduled for an in-person or telephonic visit with a clinical pharmacist and during this appointment, a shared decision-making conversation will be held where patients will receive education about pharmacogenomic testing including the testing process, associated costs, and potential benefits and risks. Patients who agree to the test will undergo pharmacogenomic testing and the sample will be sent to a testing lab for processing. Once available, the pharmacist will analyze the results and provide a recommendation to the patient’s primary care provider in the form of a consult whether the patient is indicated to continue clopidogrel or switch to an alternative antiplatelet therapy with ticagrelor or prasugrel. The recommendation will be based on the patient's predicted phenotype of ultra-rapid, rapid, normal, likely intermediate, intermediate, likely poor, or poor metabolizer based on the genotype results and the current Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline recommendations.
Specialty/Research Institute
Graduate Medical Education
