Table 2. Antiplatelet Agents—Oral P2Y12 Inhibitors
Clopidogrel (Plavix)14Prasugrel (Effient)15Ticagrelor (Brilinta)16
    Loading dose for PCI600 mg60 mg180 mg
    Loading dose for medical management300 mg180 mg
    Maintenance dose75 mg once daily10 mg once daily (Consider 5 mg once daily if patient is <60 kg)90 mg twice daily
Onset of action6 hours with 300 mg dose30 minutes60 minutes
2 hours with 600 mg dose
Perioperative considerationsHold for 5 days prior to surgeryHold for 7 days prior to surgeryHold for 5 days prior to surgery
Clinical pearls
Genetic polymorphisms of the CYP 2C19 enzyme lead to variable antiplatelet effectsNot FDA approved for medical management, only for patients undergoing PCIShould not be used with daily aspirin maintenance doses of >100 mg
Currently, the only generic prescription optionContraindicated in patients with prior stroke or TIAMay cause dyspnea, bradyarrythmias, and ventricular pauses
No net benefit for patients <60 kg and patients ≥75 years of ageUndergoes 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.