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Clopidogrel is a prodrug that is metabolized by CYP2C19 into its active metabolite. Polymorphisms in the enzyme can lead to reduced function causing decreased levels of the active metabolite of clopidogrel. The POPular Genetics Trial compared outcomes between carriers (received ticagrelor or prasugrel) and non-carriers (received clopidogrel) undergoing primary PCI for STEMI. The genotype-guided approach was non-inferior to standard treatment in thrombotic events and had fewer bleeding events.

Is genotyping routinely considered when choosing between P2Y12 inhibitors? Will genotyping become the standard of practice? What other medications may benefit from using genotype-guided approaches?