From the Guidelines
For patients experiencing an acute cerebrovascular accident (CVA) after clopidogrel (Plavix) failure, the recommended dose of ticagrelor is a loading dose of 180 mg followed by 90 mg twice daily for maintenance therapy, as indicated in the guidelines 1. This regimen should be initiated as soon as possible after determining clopidogrel failure. The maintenance dose of 90 mg twice daily should be continued for at least 90 days following the acute event, though longer durations may be appropriate based on individual risk factors. Ticagrelor should be administered with low-dose aspirin (usually 81 mg daily) for enhanced antiplatelet effect, as noted in the guidelines 1. It's essential to monitor patients for bleeding complications, and dose adjustments may be necessary for those with renal impairment. Ticagrelor is contraindicated in patients with active pathological bleeding, history of intracranial hemorrhage, or severe hepatic impairment, highlighting the need for careful patient selection and monitoring 1. Patients should be advised not to discontinue therapy without consulting their healthcare provider due to the risk of rebound thrombotic events. Key considerations include:
- Loading dose: 180 mg
- Maintenance dose: 90 mg twice daily
- Duration: at least 90 days, with potential for longer durations based on individual risk factors
- Concomitant therapy: low-dose aspirin (81 mg daily)
- Monitoring: bleeding complications, renal impairment
- Contraindications: active pathological bleeding, history of intracranial hemorrhage, severe hepatic impairment.
From the Research
Ticagrelor Dosing in Acute CVA after Clopidogrel Failure
- The recommended dose of ticagrelor in the setting of acute Cerebrovascular Accident (CVA) after clopidogrel failure is not directly stated in the provided studies.
- However, the studies suggest that ticagrelor can be used as an alternative to clopidogrel in patients with acute coronary syndromes or cerebrovascular events 2, 3, 4.
- The typical loading dose of ticagrelor is 180 mg, followed by a maintenance dose of 90 mg twice daily 2, 3, 4.
- In the context of acute stroke or transient ischemic attack, ticagrelor has been shown to be effective in preventing recurrent stroke and cardiovascular events, particularly in patients with ipsilateral atherosclerotic stenosis 5.
- The SOCRATES trial found that ticagrelor was superior to aspirin in preventing stroke, myocardial infarction, or death at 90 days in patients with acute ischemic stroke or transient ischemic attack associated with ipsilateral atherosclerotic stenosis 5.
Key Considerations
- The decision to use ticagrelor in the setting of acute CVA after clopidogrel failure should be based on individual patient factors, including the presence of atherosclerotic stenosis and the risk of bleeding 6, 5.
- Ticagrelor has been shown to have a higher risk of bleeding compared to clopidogrel, particularly in older patients 6.
- The choice of antiplatelet therapy should be guided by the patient's clinical presentation, medical history, and concomitant medications 2, 3, 4.