Table 2. Antiplatelet Agents—Oral P2Y₁₂ Inhibitors

	Clopidogrel (Plavix)¹⁴	Prasugrel (Effient)¹⁵	Ticagrelor (Brilinta)¹⁶
Dosing
Loading dose for PCI	600 mg	60 mg	180 mg
Loading dose for medical management	300 mg		180 mg
Maintenance dose	75 mg once daily	10 mg once daily (Consider 5 mg once daily if patient is <60 kg)	90 mg twice daily
Onset of action	6 hours with 300 mg dose	30 minutes	60 minutes
Onset of action	2 hours with 600 mg dose
Perioperative considerations	Hold for 5 days prior to surgery	Hold for 7 days prior to surgery	Hold for 5 days prior to surgery
Clinical pearls
	Genetic polymorphisms of the CYP 2C19 enzyme lead to variable antiplatelet effects	Not FDA approved for medical management, only for patients undergoing PCI	Should not be used with daily aspirin maintenance doses of >100 mg
	Currently, the only generic prescription option	Contraindicated in patients with prior stroke or TIA	May cause dyspnea, bradyarrythmias, and ventricular pauses
		No net benefit for patients <60 kg and patients ≥75 years of age	Undergoes CYP 3A4 metabolism (concern for drug interactions)
			Only agent shown to have mortality benefit

PCI, percutaneous coronary intervention; FDA, U.S. Food and Drug Administration; TIA, transient ischemic attack.