Implementing CYP2C19-guided clopidogrel therapy: a scoping review of pharmacogenomic testing services

• Published in: The pharmacogenomics journal Vol. 25; no. 3; p. 12
• Main Authors: Patel, Tark J., Wehbe, Eman, Hughes, Stephen, Patanwala, Asad E., Kritharides, Leonard, Lal, Sean, Patel, Sanjay, Stocker, Sophie L.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2025; Nature Publishing Group
• Subjects: 692/700/228; 692/700/478; Biomedical and Life Sciences; Biomedicine; Clopidogrel; Clopidogrel - adverse effects; Clopidogrel - therapeutic use; Cytochrome P-450 CYP2C19 - genetics; Drug stores; Education; Electronic health records; Gene Expression; Genotype & phenotype; Heart attacks; Hospitals; Human Genetics; Humans; Ischemia; Laboratories; Medical personnel; Myocardial infarction; Oncology; Pharmacogenomic Testing - methods; Pharmacogenomics; Pharmacotherapy; Pharmacy; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Precision Medicine - methods; Psychopharmacology; Repatriation; Review; Review Article; Subject heading schemes
• ISSN: 1470-269X; 1473-1150; 1473-1150
• DOI: 10.1038/s41397-025-00371-4

Pharmacogenomic testing for CYP2C19 helps personalise clopidogrel therapy and reduces the risk of experiencing a secondary myocardial infarction in individuals with impaired CYP2C19 function. Routine testing, however, is uncommon and it is proposed that the key requirements and processes of testing services are poorly understood. This scoping review aimed to explore the literature for CYP2C19 testing services for clopidogrel and identify their commonalities to inform the design and delivery of future services. In total, 37 eligible studies describing services across hospital and community settings were retrieved. Key elements of delivery included a multi-disciplinary approach involving physicians and pharmacists, provision of pre-implementation training and education, and electronic communication of test results. Result integration into clinical decision support systems improved the practical application of pharmacogenomic testing. The identification of the key requirements and processes may be used by institutions looking to design and deliver CYP2C19 testing services to guide clopidogrel therapy.