• Weaver, Max
• Stys, Tom P.
• Hajek, Catherine
• Maryniak, Andrii
• Massmann, Amanda
• Heukelom, Joel Van

Abstract

<jats:p><jats:bold>Background:</jats:bold>Tailored P2Y12 inhibitor therapy is gaining popularity and is described as a method to balance safe and effective prescribing of clopidogrel. Based on previous work, 28% of our patients with CYP2C19 genotyping do not metabolize clopidogrel effectively (intermediate or poor metabolizers).</jats:p><jats:p><jats:bold>Aim:</jats:bold>We aim to describe the economic impact of a guided P2Y12 inhibitor strategy and the practice of escalation (clopidogrel to ticagrelor/prasugrel) and de-escalation (ticagrelor/prasugrel to clopidogrel) practices at a single health system. We hypothesize a guided approach is economically feasible vs. a universal ticagrelor or prasugrel approach. We also aim to determine how quickly clinicians escalate or de-escalate in response to CYP2C19 results.</jats:p><jats:p><jats:bold>Methods:</jats:bold>3-year (2020-2022) data was collected from our EMR. Annually an average of 950 patients received CYP2C19 testing to guide P2Y12 inhibitor therapy (n=2799), and an average of 316 patients were either escalated or de-escalated (n=949). Of the 2799 patients, clopidogrel was most often the initial P2Y12 inhibitor (n=2240), followed by ticagrelor (n=525), and prasugrel (n=34). We estimated overall medication and CYP2C19 testing costs over the course of an average year (Figure 1) based on the assumption that over the course of 1-year patients would begin on 30 days of either ticagrelor, prasugrel, or clopidogrel and escalate/de-escalate therapy thereafter as guided by testing.</jats:p><jats:p><jats:bold>Results:</jats:bold>The time to escalation was similar if the CYP2C19 result was ordered before or after the first order for P2Y12 inhibitor therapy, median of 6.2 and 6.5 days respectively (p = .07). There was a difference in time to de-escalation based on time of CYP2C19 testing in comparison to medication ordering with a median time of 32.1 and 8 days when testing was ordered before initiation and after, respectively (p &lt;.001).</jats:p><jats:p><jats:bold>Conclusion:</jats:bold>Overall, clinicians were highly responsive to CYP2C19 test results for both escalation and de-escalation of therapy.</jats:p><jats:p><jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" orientation="portrait" position="float" xlink:href="g13948.jpg" /></jats:p>

Topics

• impedance spectroscopy
• electron magnetic resonance spectroscopy