<?xml version="1.0" encoding="UTF-8"?>

<Observation xmlns="http://hl7.org/fhir">
  <id value="TxImp01"/>
  <meta>
    <profile value="http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/therapeutic-implication"/>
  </meta>
  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">Poor metabolizer of Clopidogrel</div>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact">
    <valueRelatedArtifact>
      <type value="citation"/>
      <url value="https://cpicpgx.org/guidelines/guideline-for-clopidogrel-and-cyp2c19"/>
    </valueRelatedArtifact>
  </extension>
  <status value="final"/>
  <category>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/observation-category"/>
      <code value="laboratory"/>
    </coding>
  </category>
  <category>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/v2-0074"/>
      <code value="GE"/>
    </coding>
  </category>
  <code>
    <coding>
      <system value="http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs"/>
      <code value="therapeutic-implication"/>
    </coding>
  </code>
  <subject>
    <reference value="Patient/CGPatientExample01"/>
  </subject>
  <effectiveDateTime value="2019-04-01"/>
  <performer>
    <reference value="Organization/ExampleOrg"/>
  </performer>
  <derivedFrom>
    <reference value="Observation/Pgx-geno-1001"/>
  </derivedFrom>
  <component>
    <code>
      <coding>
        <system value="http://loinc.org"/>
        <code value="51963-7"/>
      </coding>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
        <code value="32968"/>
        <display value="clopidogrel"/>
      </coding>
    </valueCodeableConcept>
  </component>
  <component>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs"/>
        <code value="therapeutic-implication"/>
      </coding>
    </code>
    <valueCodeableConcept>
      <coding>
        <system value="http://loinc.org"/>
        <code value="LA9657-3"/>
        <display value="Poor metabolizer"/>
      </coding>
    </valueCodeableConcept>
  </component>
  <component>
    <code>
      <coding>
        <system value="http://hl7.org/fhir/uv/genomics-reporting/CodeSystem/tbd-codes-cs"/>
        <code value="conclusion-string"/>
      </coding>
    </code>
    <valueString value="For clopidogrel, individuals with this diplotype are expected to have significantly reduced platelet inhibition, increased residual platelet aggregation and increased risk for adverse cardiovascular events in response to clopidogrel. Alternative antiplatelet therapy (if no contraindication) is recommended. Refer to current guidelines for dosage and recommendations at https://cpicpgx.org/guidelines/guideline- for-clopidogrel-and-cyp2c19/"/>
  </component>
</Observation>