Table 5

Changes to medical management for Plavix non-responders, as determined by point of care testing

ActionResponses (No (%))Specific action
Double dose22 (43.1)
Change medication19 (37.3)Prasugrel (n=11)
Did not specify medication (n=8)
Augment with IV Abciximab (n=3)
Augment with intraoperative IA abciximab (n=1)
Aggrenox (n=1)
Re-bolus with Plavix 600 mg and recheck3 (5.88)
Ticreglor alone1 (1.96)For PED cases
Ignore and track outcomes1 (1.96)
Answer is not clear for neuroendovascular patients. A PRU <200 is associated with fewer adverse events in coronary stent population1 (1.96)Action not specified
Depends on inhibition testing1 (1.96)If inhibition is <20%+Plavix 75 mg daily and repeat test in 4–7 days. If inhibition is 20–40% add Plavix 75 mg every other day, repeat P2Y12 test in 7 days
Double dose and change medication1 (1.96)Will often ‘double dose’ Plavix and recheck with VerifyNow, if PRU still >200, will switch to Effient
Neuroform and Enterprise goal of PRU >50 and PRU <200; PED goal of PRU 50–1501 (1.96)Action not specified
Increase dose, retest, and/or change medication and retest1 (1.96)If close to therapeutic, increase Plavix dose and retest after 1–2 weeks; if little response to Plavix then switch to prasugrel 10 mg daily and retest after 1–2 weeks
  • IA, intra-arterial; IV, intravenous; PED, pipeline embolization devices; PRU, P2Y12 reaction unit.