In patients in whom there is a clear indication for PPI therapy, some clinicians may choose to use a PPI other than omeprazole. 6.1.2. Clopidogrel Genetic Testing: Recommendations Class IIb 1. Genetic testing might be considered to identify whether a patient at high risk for poor clinical outcomes is predisposed to inadequate platelet inhi- bition with clopidogrel.829 (Level of Evidence: C) 2. When a patient predisposed to inadequate platelet inhibition with clopidogrel is identified by genetic testing, treatment with an alternate P2Y12 inhibitor (eg, prasugrel or ticagrelor) might be considered.829 (Level of Evidence: C) Class III: NO BENEFIT 1. The routine clinical use of genetic testing to screen patients treated with clopidogrel who are undergoing PCI is not recommended.829 (Level of Evidence: C) On March 12, 2010, the FDA approved a new label for clopidogrel with a boxed warning about the diminished effectiveness of clopidogrel in patients with impaired ability to convert the drug into its active metabolite.829 Patients with decreased CYP2C19 function because of genetic polymor- phisms metabolize clopidogrel poorly and have higher rates of cardiovascular events after ACS and PCI than patients with Levine et al 2011 ACCF/AHA/SCAI PCI Guideline e615 normal CYP2C19 function. The warning also notes that tests are available to identify patients with genetic polymorphisms and that alternative treatment strategies should be considered for patients who are poor metabolizers. The clopidogrel boxed warning leaves the issue of whether to perform CYP2C19 testing up to the individual physician. It does not specifically require genetic testing or other changes in evaluation or treatment and does not imply that there are solid evidence-based reasons for such actions. Rather, it serves to inform clinicians of genetic variations in response to clopidogrel and to emphasize that clinicians should use this knowledge to make decisions about how to treat individual patients. 