Would you recommend genetic polymorphic testing before the initiation of antiplatelet medication in patients with ICAD?  

This is not a bad idea if a rapid test is available. If the patient has clopidogrel resistance, I would treat it with brilinta.

Do not do genetic testing. I rarely use anti-platelet therapy other than aspirin and or clopidogrel.

One option, as per the THALES trial, is to prescribe ticagrelor for one month with aspirin and then aspirin alone.

If the patient is already symptomatic with stroke or TIA, I would initiate a brief period of dual antiplatelet therapy followed by a single agent. If aspirin is chosen, there is no need for testing. I am unsure if the testing justifies the cost for a treatment duration of only 3 weeks or 3 months. O...