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CYP2C19 Genotyping to Guide Clopidogrel Prescribing for Neurovascular Indications: A Survey of Institutional

Rachael M Stone1, Glenda Hoffecker2, April Schultz3

  • 1University of Virginia, Charlottesville, Virginia, USA.

Clinical Pharmacology and Therapeutics
|July 31, 2026
PubMed

Insights

CYP2C19 genetic testing is expanding for guiding dual antiplatelet therapy (DAPT) in neurovascular care, particularly after acute ischemic stroke. Many centers adapt existing cardiovascular pharmacogenomic infrastructure to personalize clopidogrel treatment.

Area of Science:

  • Pharmacogenomics
  • Neuroscience
  • Cardiology

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard for secondary stroke prevention.
  • Clopidogrel's efficacy is limited in individuals with CYP2C19 no-function alleles.
  • CYP2C19-guided DAPT is established in cardiovascular care but less so in neurovascular indications.

Purpose of the Study:

  • To characterize current implementation strategies for CYP2C19-guided DAPT in neurovascular settings.
  • To assess how institutions are integrating CYP2C19 testing into clinical workflows for stroke and neurointerventional procedures.

Main Methods:

  • A REDCap survey was distributed to 54 institutions within the Pharmacogenomics Global Research Network Implementation Working Group.
  • Fifteen academic institutions utilizing or planning CYP2C19 testing for neurovascular indications were included.
  • Data collected included implementation status, workflows, testing logistics, clinical decision support, and guideline concordance.

Main Results:

  • Twelve institutions currently use CYP2C19 testing for neurovascular indications, primarily for acute ischemic stroke and intracranial procedures.
  • Implementation often leverages infrastructure from cardiovascular pharmacogenomics programs.
  • Most sites offer multigene panels, provide results within 7 days, and utilize clinical decision support systems.

Conclusions:

  • CYP2C19-guided DAPT for neurovascular indications is increasingly adopted, often building upon cardiovascular pharmacogenomic frameworks.
  • Alternative P2Y12 inhibitors are recommended for poor and intermediate CYP2C19 metabolizers.
  • Further research is needed to optimize clinical utility and outcomes of genotype-guided DAPT in neurovascular care.

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