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Post-PCI Antiplatelet Management — EECC MCQ

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HardCardiologyPost-PCI Antiplatelet ManagementEECC

A patient must change from ticagrelor to clopidogrel five days after ACS PCI because of intolerable dyspnoea. There is no active bleeding. Which switching principle is most appropriate?

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Correct answer: B — Use an appropriate clopidogrel loading dose timed to maintain platelet inhibition

Very early after ACS stenting, a gap in P2Y12 inhibition creates substantial stent-thrombosis risk. When de-escalation is necessary for intolerance rather than active bleeding, an appropriately timed clopidogrel loading dose is generally used to maintain inhibition, with exact timing guided by the interventional protocol. Continuing two P2Y12 inhibitors increases bleeding, while aspirin alone or warfarin does not provide equivalent early stent protection. The reason for dyspnoea should be confirmed before changing therapy.

Reference: 2023 ESC Guidelines for acute coronary syndromes. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/acute-coronary-syndromes/