{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:01:52Z","timestamp":1790859712569,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"abstract":"<jats:p>\n                    Clopidogrel is first\u2010line for secondary stroke prevention, but its effectiveness is affected by\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    genetic variation. An American Heart Association (AHA) scientific statement concluded that\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    \u2010guided P2Y12 inhibitor (P2Y12i) therapy is evidence\u2010supported, though real\u2010world application depends on implementation factors (e.g., timely, understandable results). This prospective observational cohort quality improvement project used data from three comprehensive stroke centers within one health system, each offering rapid\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    testing. Eligible patients had\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    testing ordered, a P2Y12i prescribed (clopidogrel or ticagrelor), or a P2Y12i indication. Consensus recommendations were clopidogrel for CYP2C19 normal\/rapid\/ultrarapid metabolizers (NM\/RM\/UM) and ticagrelor for intermediate\/poor metabolizers (IM\/PM). The primary target population was patients with acute ischemic stroke or TIA (AIS\/TIA) prescribed a P2Y12i. The primary outcome was the proportion of discharge ticagrelor prescriptions (among P2Y12i users) with AIS\/TIA, compared between IM\/PM and NM\/RM\/UM groups. Secondary endpoints included test turnaround time (TAT), result availability before discharge, and alignment of discharge P2Y12i with consensus recommendations (PGx\u2010aligned prescribing). The evaluation period was September 2024\u2013August 2025. Results were available for 467 patients; 451 (97%) had results before discharge, with a median TAT of 5.2\u2009hours (interquartile range 3.3\u20139.6). Of 337 patients prescribed a P2Y12i at discharge, 296 had AIS\/TIA. Clinicians more often selected ticagrelor over clopidogrel for IM\/PMs than NM\/RM\/UMs (89 of 102 [87%] vs. 11 of 194 [5.7%]; RR 15.4; 95% CI: 8.6\u201327.4;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001). PGx\u2010aligned prescribing occurred in 272 (92%) of 296 patients. Rapid\n                    <jats:italic>CYP2C19<\/jats:italic>\n                    testing efficiently translates into tailored P2Y12i prescribing in clinical practice.\n                  <\/jats:p>","DOI":"10.1002\/cpt.70504","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:37:41Z","timestamp":1790858261000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of Rapid\n                    <i>CYP2C19<\/i>\n                    Genotyping to Guide Antiplatelet Therapy for Secondary Prevention of Ischemic Stroke and Transient Ischemic Attack"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3667-2936","authenticated-orcid":false,"given":"D. Max","family":"Smith","sequence":"first","affiliation":[{"name":"MedStar Health  Columbia Maryland USA"},{"name":"Georgetown University Medical Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Ramos Ramos","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahrzad","family":"Ashena","sequence":"additional","affiliation":[{"name":"MedStar Health  Columbia Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Barnes","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Claire","family":"Barnett","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandenia L.","family":"Barrow","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rut A.","family":"Beyene","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Broussard","sequence":"additional","affiliation":[{"name":"MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8793-5815","authenticated-orcid":false,"given":"Joeffrey","family":"Chahine","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumeet","family":"Deogan","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhajni A.","family":"Gooden","sequence":"additional","affiliation":[{"name":"MedStar Health  Columbia Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliot","family":"Dawson","sequence":"additional","affiliation":[{"name":"MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Dawson","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Goff","sequence":"additional","affiliation":[{"name":"MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0214-9736","authenticated-orcid":false,"given":"Amie W.","family":"Hsia","sequence":"additional","affiliation":[{"name":"Georgetown University Medical Center  Washington DC USA"},{"name":"MedStar Washington Hospital Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"McAlduff","sequence":"additional","affiliation":[{"name":"MedStar Health  Columbia Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Moriarty","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Reuter","sequence":"additional","affiliation":[{"name":"MedStar Health  Columbia Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinna Patricia","family":"San Juan","sequence":"additional","affiliation":[{"name":"MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4380-6357","authenticated-orcid":false,"given":"Sana","family":"Somani","sequence":"additional","affiliation":[{"name":"Georgetown University Medical Center  Washington DC USA"},{"name":"MedStar Washington Hospital Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole P.","family":"Syed","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia C.","family":"Tsang","sequence":"additional","affiliation":[{"name":"MedStar Washington Hospital Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4545-576X","authenticated-orcid":false,"given":"Ariel","family":"Woodward","sequence":"additional","affiliation":[{"name":"MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimple J.","family":"Zaveri","sequence":"additional","affiliation":[{"name":"MedStar Franklin Square Medical Center  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay C.","family":"Zeck","sequence":"additional","affiliation":[{"name":"Georgetown University Medical Center  Washington DC USA"},{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4778-6226","authenticated-orcid":false,"given":"Andrew","family":"Stemer","sequence":"additional","affiliation":[{"name":"Georgetown University Medical Center  Washington DC USA"},{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1320-3830","authenticated-orcid":false,"given":"Sandra M.","family":"Swain","sequence":"additional","affiliation":[{"name":"MedStar Health  Columbia Maryland USA"},{"name":"Georgetown University Medical Center  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_12_1_1","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1161\/CIR.0000000000001412","article-title":"2026 heart disease and stroke statistics: a report of US and global data from the American Heart Association","volume":"153","author":"Palaniappan L.P.","year":"2026","journal-title":"Circulation"},{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"e364","DOI":"10.1161\/STR.0000000000000375","article-title":"2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer D.O.","year":"2021","journal-title":"Stroke"},{"key":"e_1_2_12_3_1","unstructured":"Plavix(R) [package insert]. Morristown NJ: Sanofi\u2010Aventis U.S. LLC;2025. Accesssed March 11 2026."},{"key":"e_1_2_12_4_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1001\/jama.2016.8662","article-title":"Association between CYP2C19 loss\u2010of\u2010function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack","volume":"316","author":"Wang Y.","year":"2016","journal-title":"JAMA"},{"key":"e_1_2_12_5_1","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1016\/j.jacc.2007.07.058","article-title":"Inhibition of platelet aggregation by AZD6140, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes","volume":"50","author":"Storey R.F.","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"e_1_2_12_6_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1056\/NEJMoa1916870","article-title":"Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA","volume":"383","author":"Johnston S.C.","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"e_1_2_12_7_1","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1056\/NEJMoa2111749","article-title":"Ticagrelor versus clopidogrel in CYP2C19 loss\u2010of\u2010function carriers with stroke or TIA","volume":"385","author":"Wang Y.","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"e_1_2_12_8_1","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1161\/CIR.0000000000001257","article-title":"CYP2C19 genetic testing for Oral P2Y12 inhibitor therapy: a scientific statement from the American Heart Association","volume":"150","author":"Pereira N.L.","year":"2024","journal-title":"Circulation"},{"key":"e_1_2_12_9_1","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/cts.12748","article-title":"Pharmacogenetics in practice: estimating the clinical actionability of pharmacogenetic testing in perioperative and ambulatory settings","volume":"13","author":"Smith D.M.","year":"2020","journal-title":"Clin. Transl. Sci."},{"key":"e_1_2_12_10_1","unstructured":"Genomadix Inc.510(k) substantial equivalence determination decision summary: Genomadix Cube CYP2C19 SystemK220026. Silver Spring (MD): Food and Drug Administration; 2023. <https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfpmn\/pmn.cfm?ID=K220026>. Accessed April 8 2026."},{"key":"e_1_2_12_11_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jmoldx.2018.01.011","article-title":"Recommendations for clinical CYP2C19 genotyping allele selection: a report of the Association for Molecular Pathology","volume":"20","author":"Pratt V.M.","year":"2018","journal-title":"J. Mol. Diagn."},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1002\/cpt.2526","article-title":"Clinical pharmacogenetics implementation consortium guideline for CYP2C19 genotype and clopidogrel therapy: 2022 update","volume":"112","author":"Lee C.R.","year":"2022","journal-title":"Clin. Pharmacol. Ther."},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1136\/svn-2020-000791","article-title":"Clopidogrel with aspirin in high\u2010risk patients with acute non\u2010disabling cerebrovascular events II (CHANCE\u20102): rationale and design of a multicentre randomised trial","volume":"6","author":"Wang Y.","year":"2021","journal-title":"Stroke Vasc. Neurol."},{"key":"e_1_2_12_14_1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1161\/CIRCOUTCOMES.109.921858","article-title":"Characteristics, performance measures, and in\u2010hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines\u2010stroke","volume":"3","author":"Fonarow G.C.","year":"2010","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"e_1_2_12_15_1","unstructured":"American Heart Association.Get with the guidelines\u2010heart failure registry. NCT02693509. <https:\/\/clinicaltrials.gov\/study\/NCT02693509>. 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Stroke"},{"key":"e_1_2_12_27_1","doi-asserted-by":"crossref","first-page":"7383","DOI":"10.1038\/s41598-021-86824-9","article-title":"Cost\u2010effectiveness of CYP2C19 genotyping to guide antiplatelet therapy for acute minor stroke and high\u2010risk transient ischemic attack","volume":"11","author":"Cai Z.","year":"2021","journal-title":"Sci. Rep."},{"key":"e_1_2_12_28_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/PWCB4016","article-title":"Clinical and cost\u2010effectiveness of clopidogrel resistance genotype testing after ischaemic stroke or transient ischaemic attack: a systematic review and economic model","volume":"28","author":"Carroll J.","year":"2024","journal-title":"Health Technol. Assess."},{"key":"e_1_2_12_29_1","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1038\/s41436-021-01117-w","article-title":"Expanding evidence leads to new pharmacogenomics payer coverage","volume":"23","author":"Empey P.E.","year":"2021","journal-title":"Genet. 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Ther."}],"container-title":["Clinical Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpt.70504","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cpt.70504","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpt.70504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:37:46Z","timestamp":1790858266000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascpt.onlinelibrary.wiley.com\/doi\/10.1002\/cpt.70504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":30,"alternative-id":["10.1002\/cpt.70504"],"URL":"https:\/\/doi.org\/10.1002\/cpt.70504","archive":["Portico"],"relation":{},"ISSN":["0009-9236","1532-6535"],"issn-type":[{"value":"0009-9236","type":"print"},{"value":"1532-6535","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"assertion":[{"value":"2026-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cpt.70504"}}