Impact of CYP2C19 Pharmacogenomic Testing Clinical Decision Support Alerts for Clopidogrel

Abstract

Specific Aims: To determine actions taken by healthcare providers when clinical decision support (CDS) alerts containing pharmacogenomic (PGx) best practice recommendations are fired for patients on whom clopidogrel was ordered. Methods: Banner health systems implemented a CDS alert that notifies clinicians when PGx data suggest clopidogrel may not be suitable for a patient. A list of patients who triggered this alert was generated, and investigators conducted electronic chart reviews to gather data on clinician actions and patient-related demographic information. Actions recorded included whether the healthcare provider changed the medication, modified the regimen, or took no action in response to the alert. Demographic data included age, sex, race/ethnicity, clopidogrel indication, and phenotype for CYP2C19. The study included patients who are 18 years or older, and had a CDS alert generated between June 1, 2023 and June 1, 2024. Results: In the span of one year, 257 alerts were fired for 42 patients. Of the 42 patients, 40 (95%) of those patients were intermediate metabolizers of CYP2C19 and 2 (5%) were poor metabolizers. Clopidogrel was discontinued for 15 (36%) patients and continued for the remaining 27 (64%). Of the patients for whom clopidogrel was continued, 24/27 (89%) patients had a history of prior use of clopidogrel and 16/27 (59%) were for a non-ACS indication. Of the patients for whom clopidogrel was discontinued, 6/15 (40%) were switched to an alternative antiplatelet therapy. Conclusions: PGx CDS alerts for best practice recommendations for clopidogrel instilled action among healthcare providers in their medical decision making.