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. 2026 Feb 6;17:1747121. doi: 10.3389/fphar.2026.1747121

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Copyright © 2026 Haidong, Min, Hong and Jing.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Flowchart depicting a medical decision process for secondary prevention in patients. It starts with patient admission, followed by CYP2C19 genotyping. Dual antiplatelet therapy (DAPT) is initiated with Clopidogrel and Aspirin. On day 7, a VerifyNow P2Y12 assay determines the next step. Based on genotype and PRU values, two pathways are possible: Pathway A is to continue Clopidogrel if CYP2C19 EM and PRU are less than or equal to 235; Pathway B is to switch to Ticagrelor if CYP2C19 IM/PM or PRU is greater than 235. The process concludes with a final regimen and a 12-month follow-up. — CYP2C19 genotype- and platelet reactivity-guided P2Y12 inhibitor regimen adjustment pathway.