protocolSection identificationModule nctId: NCT06292117, orgStudyIdInfo id: 230247, briefTitle: Implementation of Onsite Rapid CYP2C19 Assay for Genotype Guided Dual Antiplatelet Therapy After Acute Ischemic Stroke, acronym: ORCA-AIS, statusModule overallStatus: NOT_YET_RECRUITING, startDateStruct date: 2024-03, primaryCompletionDateStruct date: 2026-06, completionDateStruct date: 2026-06, studyFirstPostDateStruct date: 2024-03-04, lastUpdatePostDateStruct date: 2024-03-04, sponsorCollaboratorsModule leadSponsor name: University of Virginia, class: OTHER, collaborators name: American Heart Association, descriptionModule briefSummary: The goal of this observational study is to use a genetic test to help doctors prescribe the most effective medications after a patient has a stroke. One type of stroke is caused by a blood clot in brain vessels. After a patient has this kind of stroke, they are often given a combination of two blood thinners to prevent it from happening again. One of these blood thinners, called clopidogrel, is less effective in some people due to differences in their DNA. Clopidogrel needs to be activated by a specific enzyme in the body known as CYP2C19. This enzyme does not work as well if there are variations in the section of DNA that tells the body how to make CYP2C19. It can be predicted who has less CYP2C19 enzyme activity with a genetic test. If these patients are given a different blood thinner, it can reduce their risk of another stroke compared to if they are given clopidogrel.The main questions this study aims to answer are:* What are the best strategies to implement this genetic test in the hospital?* Does implementation of this genetic test change providers' decisions on which medication to prescribe after a participant has a stroke?Participants in this study will have a genetic test done onsite looking for variations in the section of DNA that tells the body how to make CYP2C19. This genetic test will only look for 11 known variations; the genome will not be sequenced. The investigators will alert the doctor of the patient's test results so they can prescribe the appropriate blood thinner. Through this, the investigators will learn the best practices for successful implementation of this genetic test., conditionsModule conditions: Ischemic Stroke, conditions: CYP2C19 Polymorphism, designModule studyType: OBSERVATIONAL, designInfo observationalModel: COHORT, timePerspective: PROSPECTIVE, enrollmentInfo count: 350, type: ESTIMATED, armsInterventionsModule interventions name: CYP2C19 Genotype, outcomesModule primaryOutcomes measure: Percentage of patients discharged from University of Virginia (UVA) Health on dual antiplatelet therapy with a diagnosis of AIS/TIA meeting eligibility criteria upon presentation that are successfully genotyped, primaryOutcomes measure: Average turnaround time of genotype result from time of collection of blood sample to time result is entered into the electronic health record, secondaryOutcomes measure: Number of CYP2C19 LOF carriers for whom a genotype-guided modification to DAPT is made, secondaryOutcomes measure: Number needed to genotype (NNG): number of patients who would need to undergo genotyping to have a recommended change in DAPT based on genotype, secondaryOutcomes measure: Stroke-free status via the Questionnaire to Verify Stroke-Free Status (QVSFS) of participants at 90 days in participants who received DAPT, secondaryOutcomes measure: Major adverse cardiovascular events at 90 days in participants who received DAPT, secondaryOutcomes measure: Correlation between P2Y12 reaction units (PRUs) measured via P2Y12 assay and CYP2C19 genotype in patients who received DAPT, otherOutcomes measure: Acceptability of deferred consent process in participants approached for full informed consent, otherOutcomes measure: Cost-effectiveness of CYP2C19-guided dual antiplatelet therapy after acute ischemic stroke, eligibilityModule sex: ALL, minimumAge: 18 Years, stdAges: ADULT, stdAges: OLDER_ADULT, contactsLocationsModule, hasResults: False