Recommended Dosage of Ticagrelor After Stent Placement
For patients who have undergone percutaneous coronary intervention (PCI) with stent placement, ticagrelor should be administered at a loading dose of 180 mg followed by a maintenance dose of 90 mg twice daily for at least 12 months.
Dosing Protocol for Ticagrelor After PCI
Initial Loading Dose
- A loading dose of 180 mg ticagrelor should be given as early as possible before or at the time of PCI 1
- This loading dose ensures rapid platelet inhibition when it's most critical
Maintenance Dosing
- Following the loading dose, patients should receive 90 mg of ticagrelor twice daily 2
- This maintenance dose should be continued for at least 12 months in patients who received a stent during PCI for acute coronary syndrome (ACS) 2
Duration of Therapy Based on Clinical Scenario
For ACS Patients
- Ticagrelor 90 mg twice daily should be given for at least 12 months in combination with aspirin 2
- Ticagrelor is preferred over clopidogrel in ACS patients due to superior outcomes 2
For Stable Coronary Artery Disease (CAD) Patients
- For drug-eluting stents (DES) in non-ACS patients: Typically clopidogrel 75 mg daily is used for at least 12 months 2
- For bare-metal stents (BMS) in non-ACS patients: P2Y12 inhibitor for a minimum of 1 month and ideally up to 12 months 2
- Ticagrelor may be considered in selected stable CAD patients at high ischemic/thrombotic risk and low bleeding risk 1
Aspirin Co-administration
- Low-dose aspirin (81 mg daily) should be used in combination with ticagrelor 2
- Higher aspirin doses should be avoided as they may reduce ticagrelor's effectiveness
Special Considerations
High Bleeding Risk Patients
- If the risk of bleeding outweighs the anticipated benefit of 12 months of ticagrelor therapy, earlier discontinuation (< 12 months) may be reasonable 2
- Recent evidence suggests that after 3 months of dual antiplatelet therapy (DAPT), continuing with ticagrelor monotherapy (without aspirin) may reduce bleeding while maintaining anti-thrombotic efficacy 3
Renal Impairment
- No dose adjustment is required for patients with renal impairment 4
- Ticagrelor can provide benefits in patients with impaired renal function without increased bleeding risk
Contraindications and Precautions
- Ticagrelor should be discontinued at least 5 days before planned surgery 1
- Contraindications include history of intracranial hemorrhage, active pathological bleeding, and severe hepatic impairment 1
Monitoring
- Routine platelet function testing to adjust ticagrelor dosing is not recommended 2
- Patients should be counseled about the importance of medication adherence, especially with the twice-daily dosing schedule
Remember that premature discontinuation of ticagrelor significantly increases the risk of stent thrombosis, myocardial infarction, and death. Patient education about the importance of adherence to the prescribed regimen is crucial for optimal outcomes.