Describe the strategy for switching between Brilinta and Plavix in the early/acute phase.

• A. Administer a 600 mg Plavix loading dose 24 hours after last Brilinta dose followed by maintenance dosing
• B. Stop Brilinta and start Plavix immediately with no loading
• C. Double Brilinta dose
• D. Do not switch

Answer: (A)

Switching from ticagrelor to clopidogrel in the acute phase is done by stopping ticagrelor and then giving a loading dose of clopidogrel after a short washout (about 24 hours) followed by maintenance dosing. The idea is to allow ticagrelor’s effect to fall off so that clopidogrel can establish a reliable, irreversible P2Y12 blockade quickly. A 600 mg loading dose of clopidogrel rapidly achieves therapeutic platelet inhibition, then continuing 75 mg daily maintains it. This approach balances maintaining antiplatelet protection with minimizing overlapping potent effects and bleeding risk.

Giving clopidogrel immediately with no loading risks a slower onset of clopidogrel’s effect and potential suboptimal platelet inhibition during the transition. Doubling ticagrelor dose is inappropriate for a switch and increases bleeding risk. Not switching would fail to optimize therapy in a scenario where a change is indicated.