Antiplatelet Conversion - Switching Between Oral P2Y12 Inhibitors A, Switching between oral agents in the acute/early phase. In the acute/early phase (≤30 days from the index event), switching should occur with the administration of a loading dose (LD) in most cases, with the exception of patients who are deescalating therapy because of bleeding or bleeding concerns, in whom a maintenance dose (MD) of clopidogrel (C) should be considered. Timing of switching should be 24 hours after the last dose of a given drug, with the exception of when escalating to prasugrel (P) or ticagrelor (T), when the LD can be given regardless of the timing and dosing of the previous clopidogrel regimen. *Consider de-escalation with clopidogrel 75-mg MD (24 hours after last prasugrel or ticagrelor dose) in patients with bleeding or bleeding concerns. B, Switching between oral agents in the late/very late phase. In the late/very late phase (>30 days from the index event), switching should occur with the administration of an MD 24 hours after the last dose of a given drug, with the exception of patients changing from ticagrelor to prasugrel therapy, for whom an LD should be considered. De-escalation from ticagrelor to clopidogrel should occur with administration of an LD 24 hours after the last dose of ticagrelor (but in patients in whom de-escalation occurs because of bleeding or bleeding concerns, an MD of clopidogrel should be considered). DOI: 10.1161/CIRCULATIONAHA.117.031164 #P2Y12 #Inhibitor #switching #conversion #Clopidogrel #plavix #antiplatelet #ticagrelor #prasugrel #pharmacology
