Early evaluation of a novel alert within cardiac procedural areas to facilitate genotype-guided antiplatelet therapy

Introduction

Clopidogrel remains widely utilized in patients undergoing percutaneous coronary intervention despite compelling evidence that genetic variation impacts patient response to clopidogrel. Clinical decision support (CDS) is frequently used to aid in precision medicine; however, limitations within the electronic medical record can hinder reliable CDS. Procedural areas where standard order entry is not utilized create a barrier to CDS implementation.

Objectives

We aimed to evaluate the implementation of a novel alerting mechanism on genotype-guided antiplatelet prescribing within the cardiac catheterization laboratory procedural setting.

Methods

A retrospective cohort study was conducted to assess the rate of antiplatelet ordering in patients with one or two loss-of-function cytochrome P450 2C19 (CYP2C19) alleles before and after alert implementation. Pharmacogenomic congruence was measured before and after the alert via chart abstraction that included the CYP2C19 genotype and antiplatelet medications ordered within that encounter.

Results

A total of 236 patients were included in analyses, 127 encounters within the cohort before alert implementation and 136 encounters in the cohort after alert implementation. Prior to alert implementation, 40.9% (n = 127) were prescribed clopidogrel compared with 25.7% (n = 136) post implementation. After implementing a genotype-guided alert within the cardiac catheterization laboratory procedural setting, providers were 2.22 times more likely to prescribe an alternative antiplatelet (p = 0.024). Clopidogrel-naïve patients were 9.75 times more likely to receive a genotype-guided antiplatelet order following alert implementation (p < 0.05).

Conclusion

Providers were responsive to a novel alert within the cardiac catheterization laboratory procedural setting. Genotype-guided antiplatelet prescribing significantly increased following the alert implementation.