Feasibility of Community Pharmacist-Initiated and Point-of-Care CYP2C19 Genotype-Guided De-Escalation of Oral P2Y12 Inhibitors

Figures

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  Figure 1. Patient and pharmacist journey per study patient undergoing POC (POC) CYP2C19 testing in the community pharmacy. Patients of participating community pharmacies with an indication for ticagrelor or prasugrel for at least three months are recruited by their community pharmacist. After informed consent, patients are genotyped for CYP2C19 *2, *3, and *17 in the community pharmacy. Patients with only CYP2C19*1 and *17 allele are eligible for antiplatelet therapy de-escalation and switched to clopidogrel in consultation with treating cardiologist. Upon cardiologist’s approval, pharmacists communicate therapy de-escalation to clopidogrel with patients. Patients with a loss-of-function (LOF) CYP2C19 *2 or *3 polymorphism remain on ticagrelor or prasugrel antiplatelet therapy. All CYP2C19 test results are communicated with the patients by the pharmacist. All (1) patients with a CYP2C19 test result, (2) participating pharmacists, and (3) treating cardiologists- who have been approached by pharmacists for de-escalation to clopidogrel- are invited to participate in a general survey on POC CYP2C19 testing in the community pharmacy.

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  Figure 2. Patient survey results on pharmacogenetic testing in community pharmacy. DNA test: pharmacogenetic test. Percentages may not add to 100% because of rounding.

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  Figure 3. Patient survey results on the added value of pharmacogenetic testing. DNA test: pharmacogenetic test. Percentages may not add to 100% because of rounding.

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  Figure 4. Community pharmacists’ ranking of ten commonly perceived barriers [32] to the implementation of PGx testing in community pharmacies. The average barrier score is the average score from 0 to 10 given to each barrier by each community pharmacist (n = 14). The barrier with the highest score is ranked first, while the barrier with the lowest score value is ranked least. Matrix ranking and barrier scores given by each community pharmacists are presented in Supplementary Table S5. PGx, pharmacogenetics; POC, point-of-care.