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Table 3 Implementation approaches at two UF Health locations and lessons learned

From: Clinical implementation of rapid CYP2C19 genotyping to guide antiplatelet therapy after percutaneous coronary intervention

Approach UF Health Jacksonville UF Health Gainesville Comment
Genotyping Rapid genotyping using a Spartan RX™ platform, with results entered into the EHR approximately 90 min from sample collection Genotyping using a GenMark DX® platform, with samples batched for processing and results entered into the EHR in an average of 3.5 days Delays in obtaining genotype results can create significant disruptions in workflow that can be minimized when genotype results are available early after PCI
Rapid genotyping is feasible for sites where the cardiac catheterization laboratory is in close proximity to the clinical pathology laboratory
Antiplatelet therapy There was a high use of prasugrel or ticagrelor early after PCI regardless of genotype. Use of prasugrel or ticagrelor declined in the 6 months following PCI for patients without a nonfunctional allele, but remained high in PMs, with two nonfunctional alleles There was high use of clopidogrel as the preferred antiplatelet therapy early after PCI. After genotype results were available, there was a high switch rate to prasugrel or ticagrelor in both PMs and IMs Genotype is important to inform switches from clopidogrel to prasugrel or ticagrelor in patients with a nonfunctional allele
Genotyping can also inform de-escalation from more potent P2Y12 inhibitors to clopidogrel in patients without a non-functional allele
Clinical pharmacy support and electronic clinical decision support No clinical pharmacy support or electronic clinical decision support was provided Significant pharmacist effort was devoted toward monitoring genotype test adoption and following up with physicians on test results in the first year of implementation. After the first year, pharmacist effort was limited to providing recommendations for patients with a nonfunctional allele. Clinical pharmacist and electronic decision support is important in settings where return of genotype results is delayed
Clinical pharmacist and/or electronic decision support may be necessary in settings where rapid genotyping is available to assist with decisions regarding antiplatelet therapy in the acute setting as well as decisions to de-escalation of chronic antiplatelet therapy