Enoxaparin systemic is used for acute coronary syndrome, angina, deep vein thrombosis, deep vein … A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic clopidogrel reviews Reviews and Meta-Analyses extension for Scoping Reviews 16. Clopidogrel should not be taken if you have stomach ulcers (can lead to bleeding) or bleeding in your brain (brain hemorrhage). Embark on a journey towards comprehensive health maintenance, where steadfast commitment to treatment fosters a horizon of enduring well-being and vitality. Discover the enduring assistance provided by steadfast pharmacological regimens.

• The sample type was recorded as a “buccal swab”, “blood sample” or “saliva sample”.
• Hematuria was the only clinical manifestation that resolved spontaneously.
• Integrating results within CDS systems and development of nationwide single patient health records has the potential to further the practical application of pharmacogenomics within practice.
• This condition is characterized by an imbalance between myocardial oxygen supply and demand, primarily arising due to atherosclerosis of the coronary arteries 1.

Refractory angina symptoms and CYP2C19 polymorphism

Based on animal studies, a single dose of 1500 to 2000 mg/kg was lethal to mice and rats, and 3000 mg/kg was lethal to baboons. By contrast, studies utilising a point-of-care approach reported barriers related to workflow incorporation 21, 41, sample accuracy 21 and testing costs 21, 47 rather than turnaround time. Nurse and/or nurse practitioner involvement was reported by seven studies, of which only four reported on their role. In these studies, they were involved in sampling 21, 23 and consulting 33, 34. A geneticist was involved in six studies 26, 27, 30, 33, 35, 36 of which all but one 36 reported their role. They were involved in approving, sampling, analysing, reporting, and consulting.

Point of care CYP2C19 genotyping after percutaneous coronary intervention

Pharmacists who were particularly involved in analysing and reporting results indicated this lack of accessibility to be a major barrier in confidently outlining treatment recommendations 37, 53, 54. Additionally, reports of physician inexperience in this field of practice led to result interpretation and patient consultation often being an arduous task when educational resources were not linked within the EHR 33, 43, 46. However, a major barrier to achieving this has been a lack of understanding on the process of establishing and delivering such services 15. Therefore, this scoping review aims to describe various pharmacogenomic testing services and identify their common elements to inform the design and delivery of CYP2C19 testing services to guide clopidogrel therapy.

• You may need to stop using clopidogrel for a short time before a surgery, medical procedure, or dental work.
• Result integration into clinical decision support systems improved the practical application of pharmacogenomic testing.
• Several guidelines, such as those from Australia and Canada, recommend ticagrelor or prasugrel as the first-line agents part of dual antiplatelet therapy post MI 7, 8.
• A point-of-care approach was described by five studies (three community, two hospital), which all reported using a buccal swab for patient sampling.

A pharmacogenomic guided approach to prescribing helps improve medication efficacy and safety and reduces adverse effect occurrence 2. Organisations such as the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group (DPWG) provide evidence-based guidelines for drugs affected by pharmacogenomic variations. Together, they provide evidence for over 40 unique gene-drug pairs, including CYP2C19 and clopidogrel 3. Clopidogrel is an antiplatelet most commonly used for the secondary prevention of a myocardial infarction (MI) following catheter revascularisation 4. As a pro-drug, it relies on CYP2C19 for bioactivation to its active metabolite for its antiplatelet effects 5.

LK, SL and LP were responsible for reviewing multiple versions of the manuscript. SLS was responsible for designing the review protocol, project administration and reviewing multiple versions of the manuscript. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Related treatment guides

Thus, institutions looking to implement a CYP2C19 testing service to guide clopidogrel therapy may use the findings of this review as a basis for building and designing their service. There is a growing body of evidence supporting routine CYP2C19 testing. Thus, it is important these recommendations are followed and a move towards routine clinical use of such services is made. Results were separated into two distinct tables and were grouped according to the healthcare setting in which the service was implemented. This was classified as either “hospital” or “community”. Testing that occurred in a medical centre (defined as an institution providing primary healthcare services with no distinct description of hospital features) or specialist clinic was classified as occurring in the “community”.

The laboratory would email or fax the results to the pharmacists, who would then analyse and generate a report outlining treatment recommendations for the GP and patients. They would then consult with the patient to explain their PGx results and their implications on treatment, and whether any treatment changes were to occur. In hospital-based services (B), numerous HCPs received training (e.g., clinicians, nurses, pharmacists) prior to study implementation. Patients were enrolled and tested if they had been, or were going to be, prescribed clopidogrel as indicated through an EHR alert.

A follow-up period of months was conducted for patients, during which they were contacted via phone calls. The purpose of this follow-up was to assess adherence to the prescribed medication regimen and evaluate the occurrence of any subsequent cardiovascular events following the PCI procedure. The assessed cardiovascular events included refractory angina symptoms, MACE, and bleeding events. Prescribed following Watchman (Afib) implant in left atrium to prevent blood clots to brain. Covered with purple and blue bruises with little to cause them.

What happens if I miss a dose?

Search results were imported into Covidence where duplicates were removed. Two independent reviewers (TJP, EW) then performed title and abstract screening, followed by full text screening for articles meeting the eligibility criteria. Eligible studies were then included for data extraction. A third reviewer (SLS) helped reach a final consensus where conflicts were unable to be resolved. Following a stroke 5 weeks ago I was prescribed 75 mg of Clopidogrel after taking a two week course of 300mg Aspirin.

Community based services generally sent samples to external laboratories (10/14, 71%) for analysis whilst hospital based services utilised an internal laboratory more frequently (14/22, 64%). A point-of-care approach was described by five studies (three community, two hospital), which all reported using a buccal swab for patient sampling. Clopidogrel, a second-generation thienopyridine, is a prodrug absorbed through the intestines via the P-glycoprotein pump following oral administration. Once absorbed, it undergoes metabolism via two primary pathways. The first pathway involves esterase enzymes, resulting in the hydrolysis of clopidogrel to a non-active carboxylic acid derivative, which accounts for 85% of the parent drug.

What should I do if I miss a dose of clopidogrel?

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Brilinta (ticagrelor) is used to lower your risk of having a stroke or serious heart problems after … Lovenox is used to prevent deep vein thrombosis (DVT) which can lead to blood clots in the lungs … This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

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.

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

Where reported, the average turnaround time of the CYP2C19 genotype result was extracted, allowing comparison between time and location of sample analysis. Data on training and education was recorded as “yes” or “no” depending on whether any training/education programs were described, and whether they were mandatory or optional. The mode of training (e.g., online webinar) was also collected. Methods of result notification (e.g., physician notified via e-mail), and documentation (e.g., results integrated into the electronic health record (EHR)) were also summarised. Additionally, key process outcomes (e.g., physician acceptance rates) (see Table S6), and barriers relating to service implementation were also recorded.