2026 Southeastern Residency Conference

Background: Despite its prevalence in clinical practice and its widely accepted role in dual antiplatelet therapy regimens, clopidogrel has demonstrated significant interpatient pharmacokinetic variability and pharmacodynamic responses. Poor metabolizers are at increased risk of cardiovascular events following coronary stenting secondary to their inability to properly metabolize the inactive compound into its active form. Platelet reactivity testing measures the degree of platelet aggregation following the administration of an antiplatelet. Using the VerifyNow-P2Y12 Assay, a P2Y12 reaction unit (PRU) ≤208 indicates adequate platelet inhibition, while a PRU >208 indicates inadequate platelet inhibition.  Current acute coronary syndrome guidelines do not recommend platelet function testing, however the JACC International Consensus Statement on Platelet Function and Genetic Testing in Percutaneous Coronary Intervention recommends consideration of platelet function testing to guide escalation strategies, de-escalation strategies, or in patients being considered for antiplatelet monotherapy with clopidogrel. In response to a sentinel event at Prisma Health where a patient with a PRU >208 was discharged on clopidogrel, PRU results were added to clinical monitoring for pharmacist assessment. The goal of this research is to assess pharmacist intervention following platelet function testing and characterize clopidogrel utilization in response to PRU levels.
Methods: This is a retrospective, observational cohort study including patients admitted to Prisma Health with coronary stenting and a platelet function test performed with resulting PRU level on clopidogrel. Patient cohorts include those with levels ≤208 (clopidogrel responders) and those with levels >208 (clopidogrel non-responders). The primary endpoint is the percentage of patients on clopidogrel with a PRU >208 that were intervened on by a pharmacist. Secondary endpoints include percentage of patients with high-risk characteristics, contraindications to a preferred P2Y12 inhibitor, appropriate PRU timing and transition to alternative P2Y12 inhibitor, and cardiovascular outcomes.  
Results: In progress
Conclusion: In progress