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Evaluation of pharmacogenetic automated clinical decision support for clopidogrel

Amanda Massmann1,2, Joel Van Heukelom1,2, Max Weaver1

  • 1Sanford Imagenetics, Sioux Falls, SD 57105, USA.

Pharmacogenomics
|September 11, 2024
PubMed

Insights

Clinical decision support (CDS) alerts effectively guided clopidogrel prescribing by leveraging CYP2C19 pharmacogenetic testing, reducing potential drug-gene interactions. Acceptance rates significantly increased over time and varied by clinician specialty.

Area of Science:

  • Pharmacogenomics
  • Clinical Decision Support Systems
  • Cardiovascular Pharmacology

Background:

  • Clopidogrel's antiplatelet efficacy depends on CYP2C19 enzyme activation.
  • Identifying patients with impaired CYP2C19 function is crucial for optimizing clopidogrel therapy.
  • Clinical decision support (CDS) alerts can integrate pharmacogenetic data to guide prescribing.

Purpose of the Study:

  • To evaluate the impact of CYP2C19-clopidogrel CDS alerts on antiplatelet prescribing practices.
  • To assess trends in CDS alert acceptance rates over time.
  • To identify factors influencing the effectiveness of CDS alerts.

Main Methods:

  • Retrospective analysis of 866 patients receiving CYP2C19-clopidogrel CDS between 2015-2023.
  • Evaluation of 2,288 CDS alerts and their acceptance rates.
  • Adjusted analyses to determine factors associated with alert acceptance.

Main Results:

  • CDS alert acceptance rates significantly increased from 24% in 2015 to 63% in 2023 (p < 0.05).
  • Higher acceptance rates were observed when clopidogrel was prescribed for percutaneous interventions (OR: 28.7, p < 0.001).
  • Cardiologists showed higher alert acceptance rates (OR: 2.11, p = 0.001).

Conclusions:

  • CDS integrated with CYP2C19 pharmacogenetic testing effectively reduced potential drug-gene interactions with clopidogrel.
  • The impact of CDS alerts was influenced by clinician specialty and the indication for clopidogrel.
  • CDS systems demonstrate value in optimizing antiplatelet therapy based on genetic profiles.

Keywords:
clinicalclopidogrelcytochrome P-450 CYP2C19decision support systemselectronic health recordsgenetic testingpatient safetypharmacogeneticspharmacyplatelet aggregation inhibitorsprecision medicine

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