Also Known As
Clopidogrel Pharmacogenetic Testing
CYP2C19 Genotype
Formal Name
CYP2C19 Sequence Genotype
This article was last reviewed on
This article waslast modified on January 4, 2018.
At a Glance
Why Get Tested?

To help evaluate your likely response to the antiplatelet drug clopidogrel by detecting variations in the gene (CYP2C19) that codes for one of the enzymes that metabolizes the drug; clopidogrel is prescribed for people who are at risk of a heart attack or stroke to help prevent harmful blood clots from forming.

When To Get Tested?

A health practitioner might order this test prior to prescribing clopidogrel for you or during the initial treatment phase and sometimes when you are taking clopidogrel and are not responding as expected.

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

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Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

This test helps determine if a person may be less responsive to the drug clopidogrel because of his or her genetic makeup. This test detects genetic variation in the gene CYP2C19. A health practitioner may sometimes order this test to determine whether clopidogrel will be effective for the person tested or if another drug for treatment may be required.

Clopidogrel is a drug that is part of a group of medications called antiplatelet drugs and is used to prevent strokes and heart attacks in people who are at increased risk for these serious cardiovascular events. The drug works by helping to prevent harmful blood clots from forming by preventing platelets from clumping together (aggregating).

Normally, when an injury occurs to blood vessels, platelets in the blood stick to the site of injury and clump together to start the formation of a blood clot and help stop the bleeding. In people at increased risk for heart attack or stroke, this process can occur inappropriately, so they may be treated with drugs that prevent platelet aggregation.

Clopidogrel is given in an inactive form (i.e., prodrug) and must be changed (metabolized) by the body to an active form before it can be effective. Some people who have some genetic variations in the gene CYP2C19 do not metabolize clopidogrel to its active form as well as people who do not have these genetic variations in CYP2C19. Therefore, individuals with CYP2C19 genetic variations who are taking clopidogrel may not receive adequate benefit from the drug and may be at risk of having a heart attack or stroke. This test identifies people who have one or more CYP2C19 variants.

Each person receives one copy of each of their genes from their mother and one copy of each of their genes from their father. Thus, the CYP2C19 gene is present in the body as two inherited gene copies (alleles). Any person could have both copies of a gene without any variants (wild-type); one copy without variants and one copy with a variant (heterozygous); both copies with the same variant (homozygous); and both copies with different variants (compound heterozygous). The combination of the CYP2C19 gene copies that a person has can determine how effectively clopidogrel is changed to its active form in the body and its overall effect.

Clopidogrel responsiveness (or clopidogrel genotype) testing determines whether CYP2C19 gene variants are present. Careful interpretation of the results can help the healthcare provider decide the appropriate antiplatelet treatment for the person tested.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

Accordion Title
Common Questions
  • How is it used?

    This test is used to determine an individual's potential responsiveness to clopidogrel, an antiplatelet medication, before a person starts taking the drug or during the initial treatment phase. Clopidogrel is a drug that is prescribed to prevent strokes and heart attacks in people who are at increased risk for these serious cardiovascular events. The drug works by helping to prevent harmful blood clots from forming by preventing platelets from clumping together (aggregating).

    Clopidogrel genotype testing is used to detect variation in the CYP2C19 gene that codes for one of the enzymes responsible for metabolizing clopidogrel into its active form. Variation in CYP2C19 is most often associated with reduced enzyme activity and decreased metabolism of clopidogrel, leading to a low level of active drug and potentially ineffective treatment for risk of blood clots. Testing for variants of the CYP2C19 gene is done to help tailor treatment for an individual (known as pharmacogenetic testing). Those with certain genetic variations may require an alternative therapy that would treat their condition more effectively.

    Clopidogrel-related genetic testing is not widely used at this time. Although studies have shown that CYP2C19 variation contributes to a person's responsiveness to clopidogrel, there is no agreement yet among experts on the need for the testing. Part of the reason is that genetic variants of CYP2C19 explain only a small proportion of the treatment response variability among people.

  • When is it ordered?

    Clopidogrel resistance testing is primarily ordered prior to a person taking clopidogrel for the first time or during the initial treatment phase but may also be ordered when a person who is being treated with the drug has experienced either excessive blood clotting or bleeding.

    Not everyone who is prescribed clopidogrel will have this test done. At present, there is no consensus on the usefulness of this test and it is not yet widely accepted.

  • What does the test result mean?

    Results of genetic testing require careful interpretation. Typically, the lab report will include an explanation from a health practitioner with expertise in this area. A number of factors are taken into account when determining whether clopidogrel is an appropriate treatment for an individual.

    In general, if a person has one or two variant copies of the gene, then that person may have an altered response to clopidogrel. The degree of responsiveness depends upon the variation(s) present and upon the person. An individual may be a normal, poor, intermediate, extensive, or ultra-rapid metabolizer of the drug.

    Not every laboratory will test for every gene variant. A less common gene variant may be present that is not detected by the test. A person may also have decreased drug metabolism due to another factor. CYP2C19 gene variation only accounts for a portion of a person's response to clopidogrel.

  • Is there anything else I should know?

    To increase awareness of the influence of the CYP2C19 gene variations and the availability of testing, the U.S. Food and Drug Administration (FDA) has promoted changes to the Plavix® (clopidogrel) label to inform consumers that genetic factors may affect how well the drug works for them.

    The enzyme CYP2C19, coded for by the CYP2C19 gene, metabolizes a wide variety of drugs in addition to clopidogrel. Thus, if a person is taking clopidogrel plus one or more additional medications metabolized by CYP2C19, then that person may have altered metabolism of clopidogrel and the other drugs. One of the prominent examples of drugs that are metabolized by CYP2C19 is omeprazole that is taken to control stomach acid production. Others include diazepam, anti-seizure medications, and antidepressants.

    Testing to predict how someone will respond to a drug is a form of personalized medicine known as pharmacogenomics. It is a relatively new field of study developed in an effort to treat individuals' conditions effectively, yet avoid side effects.

  • Is this test different than a platelet function test?

    Yes. This test is a genetic test that determines which form of the CYP2C19 gene you have, which may help predict how you will respond to clopidogrel.

  • Can platelet function assays be used to assess clopidogrel response?

    There are several platelet function assays that have been used for detecting nonresponse (termed "clopidogrel resistance"), such as platelet aggregometry with ADP, with collagen epinephrine; however, their clinical utility has not been widely accepted due to poor agreement between the assays.

  • Should everyone be tested for CYP2C19 gene variations?

    Testing is not recommended to screen the general population. It is currently only indicated for those taking a drug that may be influenced by the activity of the CYP2C19-related enzymes. In some cases, a health practitioner may recommend that family members of a poor metabolizer consider testing so that this information is on record.

  • Can clopidogrel resistance testing be done in my doctor's office?

    No, it requires specialized equipment to perform and expertise to interpret. It is not offered by every laboratory and may need to be sent to a laboratory outside of your hospital (reference laboratory).

  • Should I tell my other healthcare providers about my CYP2C19 test results?

    Yes, this would be good information for them to have, regardless of whether you are currently taking clopidogrel.

  • Should I tell my healthcare providers that I am taking clopidogrel?

    Yes, it is crucial for you to tell all of your healthcare providers and your dentist that you are taking clopidogrel, aspirin, or another antiplatelet agent. They will need to incorporate this information into any other treatments or procedures.

View Sources

Sources Used in Current Review

Michael J. Knauer, Moderator, Eleftherios P. Diamandis, Moderator, Jean-Sebastien Hulot, Expert, Richard B. Kim, Expert and Derek Y.F. So, Expert. Clopidogrel and CYP2C19: Pharmacogenetic Testing Ready for Clinical Prime Time? Clinical Chemistry October 2015 vol. 61 no. 10 1235-1240. Available online at http://www.clinchem.org/content/61/10/1235.full. Accessed October 2015.

Gennaro Sardella, MD; Simone Calcagno, MD. The Importance of Genotype Variation Beyond Different Antiplatelet Therapy in Nonresponder Patients. J Am Coll Cardiol. 2014;64(3):333-334.

Bhopalwala A, et al. Routine Screening for CYP2C19 Polymorphisms for Patients being Treated with Clopidogrel is not Recommended. Hawaii J Med Public Health. 2015 Jan; 74(1): 16–20. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300541/. Accessed October 2015.

Levine G, et al. Expert consensus document: World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI. Nature Reviews Cardiology 11, 597–606 (2014). Available online at http://www.nature.com/nrcardio/journal/v11/n10/full/nrcardio.2014.104.html. Accessed October 2015.

Sources Used in Previous Reviews

Holmes, D et al. (2010 June 28). ACCF/AHA Clopidogrel Clinical Alert: Approaches to the FDA "Boxed Warning" A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the American Heart Association. Circulation. 2010; 122: 537-557 [On-line information]. PDF available for download at http://circ.ahajournals.org/content/122/5/537.full.pdf. Accessed July 2011.

(Reviewed 2010 November 1). Clopidogrel. MedlinePlus Drug Information [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601040.html. Accessed July 2011.

Malone, Bill (2009 March 26). Predicting Response to Clopidogrel New Evidence Links Genes with Outcomes. Clinical Laboratory Strategies [On-line information]. Available online at http://www.aacc.org/publications/strategies/archives/2009/Pages/032609.aspx. Accessed July 2011.

McMillin, G et al. (Updated 2010 August). Pharmacogenetics – PGx. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/PGx.html. Accessed July 2011.

(© 1995-2011). Unit Code 60439: Cytochrome P450 2C19 Genotype by Sequence Analysis Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/60439. Accessed July 2011.

Hughes, S. (2010 October 21). Vanderbilt Now Also Routinely Gene Testing for Clopidogrel Metabolizer Status. Medscape Today from Heartwire [On-line information]. Available online at http://www.medscape.com/viewarticle/731001. Accessed July 2011.

Momary, K. et. al. (2010 April 13). Genetic Causes of Clopidogrel Nonresponsiveness: Which Ones Really Count? Medscape Today from Pharmacotherapy. 2010;30(3):265-274 [On-line information]. Available online at http://www.medscape.com/viewarticle/719480. Accessed July 2011.

Nainggolan, L. (2010 December 21). Newly Identified Variants Are Major Predictors of Response to Clopidogrel. Medscape Today from Heartwire [On-line information]. Available online at http://www.medscape.com/viewarticle/734643. Accessed July 2011.

Hughes, S. (2011 May 5). New Study Refutes Role of PON1 Gene in Clopidogrel Treatment. Medscape Today from Heartwire [On-line information]. Available online at http://www.medscape.com/viewarticle/742206. Accessed July 2011.

Snyder, B. (2010 September 23). Patient genotypes guide drug therapy in new VU program. Reporter, Vanderbilt University Medical Center's Weekly Newspaper [On-line information]. Available online at http://www.mc.vanderbilt.edu/reporter/index.html?ID=9466. Accessed July 2011.

Hughes, S. (2010 July 22). Therapeutic Window Identified for Clopidogrel? Medscape Today from Heartwire [On-line information]. Available online at http://www.medscape.com/viewarticle/725625. Accessed July 2011.

Voora, D. and Shah, S. (2009 December 7). Defining the Link Between CYP2C19*2 and Clopidogrel Response. Medscape Today Viewpoints in Genomic Medicine [On-line information]. Available online at http://www.medscape.com/viewarticle/713197. Accessed July 2011.

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Linnea Baudhuin, Phd, DABMG. Assistant Professor of Laboratory Medicine. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

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