A multidimensional study of antiplatelet therapy and CYP2C19 genetic testing in patients with ischemic stroke and...

This study aimed to investigate the current status and associated influencing factors of antiplatelet therapy and CYP2C19 gene testing among patients with ischemic stroke and transient ischemic attack, and to identify potential entry points for precision pharmaceutical care to promote the more rational and individualized application of antiplatelet therapy.

A multidimensional research approach was used in this study. First, relevant guidelines were systematically searched and critically evaluated using evidence-based pharmaceutical methods to summarize the latest recommendations regarding antiplatelet therapy and CYP2C19 genetic testing in patients with ischemic stroke and transient ischemic attack. Subsequently, a retrospective analysis was conducted on real-world data from 147 patients to assess the actual implementation of antiplatelet therapy and genetic testing, as well as adherence to clinical guidelines. Finally, semi-structured interviews were conducted to identify the key factors influencing physicians' decisions to prescribe CYP2C19 genetic testing, based on which targeted interventions were formulated.

Five guidelines were included, all of which recommended gene-guided antiplatelet therapy, with one providing a Grade A recommendation and four offering Grade B recommendations. Among the patients, 74.83% received guideline-concordant empirical dual antiplatelet therapy, whereas 11.56% underwent CYP2C19 genetic testing but did not adjust their medication regimen according to the test results. Physicians were more likely to order genetic testing for patients with abnormal liver function while underestimating other relevant clinical factors. Interviews with 14 physicians revealed that the key factors influencing the order of CYP2C19 genetic testing included capability (knowledge and skills), opportunity (environmental and resource), and motivation (emotional). Corresponding intervention recommendations included formulating localized clinical decisions, conducting medication consultations and training, enhancing medication education, and advocating expanded medical insurance policy coverage.

The adherence to guidelines regarding antiplatelet therapy and CYP2C19 genetic testing among patients with ischemic stroke and transient ischemic attack remains suboptimal, and the clinical utility of genetic testing is yet to be fully realized. Pharmacists should deliver comprehensive and precise pharmaceutical services from multiple perspectives to promote the rationalization and individualization of antiplatelet therapy.