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Physician response to implementation of genotype‐tailored antiplatelet therapy
Author(s) -
Peterson JF,
Field JR,
Unertl KM,
Schildcrout JS,
Johnson DC,
Shi Y,
Danciu I,
Cleator JH,
Pulley JM,
McPherson JA,
Denny JC,
Laposata M,
Roden DM,
Johnson KB
Publication year - 2016
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.331
Subject(s) - cyp2c19 , medicine , clopidogrel , pharmacogenomics , hazard ratio , confidence interval , cohort , pharmacogenetics , medical prescription , genotype , pharmacology , aspirin , genetics , cytochrome p450 , metabolism , gene , biology
Physician responses to genomic information are vital to the success of precision medicine initiatives. We prospectively studied a pharmacogenomics implementation program for the propensity of clinicians to select antiplatelet therapy based on CYP2C19 loss‐of‐function variants in stented patients. Among 2,676 patients, 514 (19.2%) were found to have a CYP2C19 variant affecting clopidogrel metabolism. For the majority (93.6%) of the cohort, cardiologists received active and direct notification of CYP2C19 status. Over 12 months, 57.6% of poor metabolizers and 33.2% of intermediate metabolizers received alternatives to clopidogrel. CYP2C19 variant status was the most influential factor impacting the prescribing decision (hazard ratio [HR] in poor metabolizers 8.1, 95% confidence interval [CI] [5.4, 12.2] and HR 5.0, 95% CI [4.0, 6.3] in intermediate metabolizers), followed by patient age and type of stent implanted. We conclude that cardiologists tailored antiplatelet therapy for a minority of patients with a CYP2C19 variant and considered both genomic and nongenomic risks in their clinical decision‐making.