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Plavix Sensitivity Panel

Justification

A significant subset of patients treated with Plavix (clopidogrel) do not show adequate antiplatelet response due to factors such as variability in drug metabolism, drug interactions, and compliance, leading to increased risk of recurrent cardiovascular events. Plavix sensitivity genotyping of CYP2C19 can be used to detect the presence of alleles (CYP2C19*2, CYP2C19*3) that lead to decreased metabolism and reduced conversion of Plavix to its active form (Plavix "resistance"), or alleles (CYP2C19*17) that lead to increased metabolism and conversion of Plavix to its active form. Plavix sensitivity testing by platelet aggregometry can be used to assess the effectiveness of platelet inhibition by Plavix therapy or restoration of platelet function after discontinuation of Plavix. This test may also be used to measure effectiveness of other ADP receptor (P2Y12) antagonists, such as Effient (prasugrel) or Brilinta (ticagrelor).

Panel Component Tests

Platelet Aggregation - Plavix Sensitivity Plavix Sensitivity Genotype (CYP2C19)

STAT: < 24 hours (M-F)

LTA and RT-PCR

Draw Tube: Purple Top

Draw Tube: Blue Top

Sample Type: Citrated Whole Blood and EDTA Whole Blood

Specimen Requirements

Sample Type Volume Required Minimum Volume Stability
PREFERRED Citrated Whole Blood and EDTA Whole Blood Four tubes (3mL) Citrated Whole Blood and One tube (3mL) EDTA Whole Blood Inquire 4 hours
ALTERNATIVE - - - -
REJECTION CRITERIA See included test profiles.
SPECIAL INSTRUCTIONS -

General Information

METHODOLOGY LTA and RT-PCR
STAT TAT < 24 hours (M-F)
STAT TAT Performance -
ROUTINE TAT < 72 hours (M-F)
ALTERNATIVE NAMES -
DESCRIPTION -
LIMITATIONS See included test profiles.
NORMAL RANGE Interpretation
ASSOCIATED TESTING -
REFERENCES -
SAMPLE REPORT -
NEW YORK STATE APPROVED -

Test Codes

ORDER CODE P1193
CPT CODE 81225, 85576x4
LOINC CODE 57132-3, 5992-3