Overview
Evidence-based recommendations on CYP2C19 genotype testing to guide clopidogrel use after ischaemic stroke or transient ischaemic attack.
We are aware that a number of services are keen to understand national timelines for commissioning decisions regarding further rollout of CYP2C19 testing via NHS Genomic Medicine Service laboratories, prior to the use of clopidogrel following stroke in line with NICE diagnostics guidance 59.
NHS England confirmed that information from the pilot has informed the development of implementation guidance to inform a future national commissioning approach. However, it has not been possible to identify the necessary recurrent headroom in revenue budgets to support the routine commissioning of this testing for the indicated population at this point in time. This position is being kept under active review and takes into account the need to maintain all existing services for patients that currently receive genomic testing delivered by the NHS Genomic Medicine Service. An implementation guide has been produced by the NHS Pharmacogenomics and Medicines Optimisation Network of Excellence.
Last reviewed: 31 July 2024
Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.
Guidance development process
How we develop NICE diagnostics guidance
Your responsibility
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.