Table 3:

Current DAT protocol for PED procedures

Initiation of DAT17 Days before procedure
Target P2Y12 receptor inhibitionPRU 60–240
Target aspirin inhibition≥50%
Initial aspirin dose81 mg daily
Initial clopidogrel dose75 mg daily
Preprocedural aspirin inhibition testingaAfter ten 81-mg aspirin doses or the day before procedure
Preprocedural P2Y12 receptor-inhibition testingAfter ten 75-mg clopidogrel doses and the day before procedure
Hyporesponse to aspirin (< 50% inhibition)Aspirin, 325 mg daily
Clopidogrel dosing schedules0) 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 procedurePRU < 60 or >240 on the day before procedure
Postprocedural P2Y12 receptor-inhibition testing7–10 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.