26693963

PMC4899238

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.

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U01 HG006378/HG/NHGRI NIH HHS/United States
U01 HG007253/HG/NHGRI NIH HHS/United States
U01 HG008672/HG/NHGRI NIH HHS/United States
U01 HL105198/HL/NHLBI NIH HHS/United States
U01 HL122904/HL/NHLBI NIH HHS/United States
U19 HL065962/HL/NHLBI NIH HHS/United States
U47 CI000824/CI/NCPDCID CDC HHS/United States
UL1 TR000445/TR/NCATS NIH HHS/United States