Dual Anti-Platelet Therapy Regimens and Associated Perioperative Complications
| First Group (n=6): | Second Group (n=15): | |
| Initiation of dual anti-platelet therapy regimen | 7 days pre-procedure | 10 days pre-procedure |
| Aspirin/Clopidogrel dosing | 325 mg PO QD/300 mg PO ×1, then 75 mg PO QD | 325 mg PO QD/75 mg PO QD |
| Pre-procedure P2Y12 inhibition testing | Day of procedure | 1 day before procedure |
| Regimen for non-responders (PRUs >240 or <20% inhibition) | Prasugrel 60 mg PO × 1, then 10 mg PO QD | Prasugrel 60 mg PO × 1, then 10 mg PO QD |
| Regimen for poor responders (PRUs 200–240 or 20%–39% inhibition) | Clopidogrel 150 mg PO QD | Prasugrel 30 mg PO × 1, then 10 mg PO QD |
| Regimen for hyper-responders (PRUs <40 or ≥90% inhibition) | Clopidogrel, 75 mg PO QOD | Clopidogrel, 75 mg PO QOD |
| Post-procedure P2Y12 inhibition testing | None, unless symptomatic with abnormal bruising or bleeding | 30–45 days after first clopidogrel dose, earlier if symptomatic with abnormal bruising or bleeding |
| Thromboembolic / Hemorrhagic complications | 2 (33.3%, 1 TIA, 1 infarction leading to a new permanent neurological deficit)/1 ICH not leading to a new permanent neurological deficit (16.7%) | 1 infarction not leading to a new permanent neurological deficit (6.7%)/None |
| Overall perioperative complications | 3 (50%) | 1 (6.7%), p value: 0.053 |