UK Stroke Forum 2025 | Personalizing secondary stroke prevention by using CYP2C19 testing to guide clopidogrel treatment
David Hargroves, MB, BSc (Hons), MSc, FRCP, East Kent Hospitals NHS Trust, Kent, UK, discusses the real-world implementation of NICE DG59-recommended CYP2C19 testing to guide clopidogrel prescribing, highlighting the importance of personalized secondary prevention for patients who have suffered a stroke. Dr Hargroves explains that approximately a third of patients do not process clopidogrel effectively due to the CYP2C19 genetic mutation and that pilot testing in four centres across England has aimed to identify the patients who benefit from this antiplatelet therapy. This interview took place at the UK Stroke Forum (UKSF) 2025 Conference in Aberdeen, UK.
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Transcript
For a long time, we’ve known that personalized secondary prevention for patients that have suffered a stroke is vitally important. Not every patient responds to drugs in exactly the same way, and that’s based on their genetic profile. We’ve known for a while that there are certain individuals that have a mutation on one of their alleles, one of their genes, which means they do not process clopidogrel the same as other patients...
For a long time, we’ve known that personalized secondary prevention for patients that have suffered a stroke is vitally important. Not every patient responds to drugs in exactly the same way, and that’s based on their genetic profile. We’ve known for a while that there are certain individuals that have a mutation on one of their alleles, one of their genes, which means they do not process clopidogrel the same as other patients. We estimate that approximately a third of patients break down clopidogrel in a manner which means it is no longer in the active form and, therefore, they are not getting the benefit from clopidogrel as an antiplatelet for secondary prevention. Within England, we have piloted the use of clopidogrel testing in four centres across the country. And we are now evaluating and looking at ways in which we can roll out the systematic opportunities to deliver clopidogrel testing to all those units in England that are using it as secondary prevention. This has got a really important opportunity to reduce the secondary strokes after patients have their first.
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