Dosing of Plavix (Clopidogrel) and Apixaban for NSTEMI Post-PCI

Antiplatelet Therapy Post-PCI for NSTEMI

• The American College of Cardiology recommends a loading dose of clopidogrel 600 mg for patients not already on P2Y12 inhibitor therapy, given as early as possible before or at the time of PCI, for patients with NSTEMI post-PCI 2, 3
• For patients already on daily aspirin therapy, the American College of Cardiology recommends taking 81 mg to 325 mg non-enteric-coated aspirin before PCI, for patients with NSTEMI post-PCI 1, 2
• The American College of Cardiology recommends clopidogrel 75 mg daily for at least 12 months post-PCI, for patients with NSTEMI post-PCI 1, 4
• The American College of Cardiology recommends aspirin 81 mg daily as preferred over higher maintenance doses, for patients with NSTEMI post-PCI 1, 5

Important Considerations

• The American College of Cardiology states that apixaban is not part of standard therapy for NSTEMI post-PCI unless there is a specific indication for anticoagulation, such as atrial fibrillation, for patients with NSTEMI post-PCI 1, 5
• The American College of Cardiology recommends that prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack, for patients with NSTEMI post-PCI 1, 6
• The American College of Cardiology recommends that for patients ≥75 years or <60 kg, prasugrel is generally not recommended due to increased bleeding risk, for patients with NSTEMI post-PCI 4, 7