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Clin Pharmacol Ther. 2016 Jul;100(1):67-74. doi: 10.1002/cpt.331. Epub 2016 Feb 17.

Physician response to implementation of genotype-tailored antiplatelet therapy.

Author information

1
Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
2
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
3
Institute of Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
4
Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
5
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
6
Department of Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
7
Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
8
Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
9
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

Abstract

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.

PMID:
26693963
PMCID:
PMC4899238
DOI:
10.1002/cpt.331
[Indexed for MEDLINE]
Free PMC Article

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