Evidence mapPaperPMID 42533475Full record

ArticleClinical pharmacology and therapeutics2026

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

Rachael M Stone, Glenda Hoffecker, April Schultz, Brittney H Davis, Salma A Bargal, Amber L Beitelshees, Nihal El Rouby, Madeline Norris, Kevin J Rodriguez, Nita Limdi and 2 more

Abstract read
In one paragraph

Article in Clinical pharmacology and therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Rachael M StoneUniversity of Virginia, Charlottesville, Virginia, USA.ORCID https://orcid.org/0000-0001-7751-4948
Glenda HoffeckerUniversity of Pennsylvania, Philadelphia, Pennsylvania, USA.ORCID https://orcid.org/0000-0002-7199-2196
April SchultzSanford Imagenetics, Sanford Health, Sioux Falls, South Dakota, USA.ORCID https://orcid.org/0000-0003-1249-3685
Brittney H DavisUniversity of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0001-6717-2649
Salma A BargalUniversity of Maryland, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0001-9675-7523
Amber L BeitelsheesUniversity of Maryland, Baltimore, Maryland, USA.ORCID https://orcid.org/0000-0003-0958-7197
Nihal El RoubyUniversity of Cincinnati, Cincinnati, Ohio, USA.ORCID https://orcid.org/0000-0003-1652-3773
Madeline NorrisUniversity of Florida, Gainesville, Florida, USA.ORCID https://orcid.org/0009-0009-4463-3057
Kevin J RodriguezUniversity of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0009-0007-1475-5905
Nita LimdiUniversity of Alabama at Birmingham, Birmingham, Alabama, USA.ORCID https://orcid.org/0000-0002-4672-8406
Larisa H CavallariUniversity of Florida, Gainesville, Florida, USA.ORCID https://orcid.org/0000-0002-7184-5292
Craig R LeeUniversity of North Carolina, Chapel Hill, North Carolina, USA.ORCID https://orcid.org/0000-0003-3595-5301

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is commonly used for secondary prevention following acute ischemic stroke (AIS) and neurointerventional procedures. However, the efficacy of clopidogrel is reduced in carriers of CYP2C19 no-function alleles. While CYP2C19-guided DAPT is well-established for some cardiovascular indications, its use in neurovascular settings has remained limited until recently. This study characterized current implementation strategies for CYP2C19-guided DAPT for neurovascular indications across institutions in the Pharmacogenomics Global Research Network Implementation Working Group. A REDCap survey was distributed to 54 institutions targeting those currently utilizing or planning to implement CYP2C19 testing to guide clopidogrel use for neurovascular indications. The survey collected data on implementation status, workflows, testing logistics, clinical decision support (CDS), and guideline concordance. Fifteen institutions met inclusion criteria; 80% were in the United States and 87% were academic centers. CYP2C19 testing was used for neurovascular indications at 12 sites, most commonly for AIS, intracranial aneurysm repair, and intracranial stenting. Implementation was often built on infrastructure previously established for cardiovascular indications. Most sites used multigene panels, offered testing in both inpatient and outpatient settings, and returned results within 7 days. Eighty percent of sites provided CDS to support application of results. All sites recommended an alternative P2Y12 inhibitor (e.g., ticagrelor) for poor metabolizers, and most did for intermediate metabolizers. CYP2C19-guided antiplatelet therapy for neurovascular indications is expanding, with many implementations leveraging preexisting infrastructure from cardiovascular settings. Broader adoption and outcome-focused research are needed to optimize the clinical utility of genotype-guided DAPT in neurovascular care.

Identifiers

PMID42533475
PMCPMC13424262

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.