Table 3:
Current DAT protocol for PED procedures
| Initiation of DAT | 17 Days before procedure |
| Target P2Y12 receptor inhibition | PRU 60–240 |
| Target aspirin inhibition | ≥50% |
| Initial aspirin dose | 81 mg daily |
| Initial clopidogrel dose | 75 mg daily |
| Preprocedural aspirin inhibition testinga | After ten 81-mg aspirin doses or the day before procedure |
| Preprocedural P2Y12 receptor-inhibition testing | After ten 75-mg clopidogrel doses and the day before procedure |
| Hyporesponse to aspirin (< 50% inhibition) | Aspirin, 325 mg daily |
| Clopidogrel dosing schedules | 0) 150 mg dailyb; 1) 75 mg daily; 2) 75 mg QOD; 3) 75 mg Q3D; 4) 75 mg QMF; 5) 75 mg Q5D; 6) 75 mg Q7D; 7) 75 mg PRN to reach PRU ≥60 |
| Hyporesponse to clopidogrel (PRU > 240) | Go back 1 step in clopidogrel dosing schedule |
| Hyper-response to clopidogrel (PRU < 60) | PRU 40–59: advance 1 step in clopidogrel dosing schedule |
| PRU 10–39: advance 2 steps in clopidogrel dosing schedule | |
| PRU < 10: advance 3 steps in clopidogrel dosing schedule | |
| Reschedule procedure | PRU < 60 or >240 on the day before procedure |
| Postprocedural P2Y12 receptor-inhibition testing | 7–10 and 30–40 Days after any clopidogrel dose adjustment, after changes to medications that may affect clopidogrel metabolism, or at any time if symptomatic with abnormal bruising/bleeding or focal neurologic deficits |
Note:—QOD indicates every other day; Q3D, every third day; QMF, every Monday and Friday; Q5D, every fifth day; Q7D, once a week; PRN, dosing schedule as needed.
a
Aspirin inhibition testing performed with a standard collagen platelet aggregation assay.
b
Hyporesponders to 150-mg daily clopidogrel dose (PRU > 240) are started on ticagrelor (180 mg × 1, then 90 mg twice a day) the day before the procedure without further P2Y12 receptor-inhibition testing.