Antiplatelet Therapy

Aspirin

P2Y12 (ADP receptor) inhibitor (choose one of the following in addition to ASA).

Timing (on presentation or at angiography) remains controversial.

Ticagrelor (preferred over clopi)

Prasugrel (preferred over clopi)

Clopidogrel

Cangrelor

GP IIb/IIIa inhibitors (GPI)

abciximab; eptifibatide; tirofiban

Infusions given ≤24 h peri & post PCI; shorter (~2 h) as effective w/ ↓ bleeding (JACC 2009;53:837)

No clear benefit for routinely starting prior to PCI and ↑ bleeding (NEJM 2009;360:2176) Consider if refractory ischemia despite optimal Rx while awaiting angio or in high-risk Pts (eg, large clot burden) at time of PCI, espec if using clopi and no preRx. Consider for rapidly reversible P2Y12 inhib peri-PCI or as bridge to surgery in high-risk Pts who need to stop P2Y12

Transition from cangrelor to oral P2Y12 inhib.: ticagrelor loading dose during infusion or immediately after d/c of infusion; prasugrel or clopidogrel loading dose only immediately after d/c of infusion.