Figure 5.
Proposed Clinical Algorithms for Tailoring Clopidogrel Therapy. Proposed clinical algorithms for tailoring clopidogrel therapy based on CYP2C19 genotype (a,b) or on-treatment platelet reactivity (b). The algorithms do not account for non-genetic or other precision medicine regulators of clopidogrel resistance. 1 Only the most common CYP2C19 genotypes are illustrated; 2 Prasugrel and ticagrelor should be considered when not contraindicated clinically. ACS: acute coronary syndrome; EM: extensive metabolizer; IM: intermediate metabolizer; PCI: percutaneous coronary intervention; PM: poor metabolizer; UM: ultra-rapid metabolizer. Used with permission of John Wiley and Sons; copyright 2013 by Scott et al. Clinical Pharmacogenetics Implementation Consortium guidelines for CYP2C19 genotype and clopidogrel therapy: 2013 update. [68]; and used with permission of Elsevier; copyright 2017 [107].