This handout is for post-pci stent thrombosis (nstemi presentation). Your care team identified this based on: prior coronary stent + new acs presentation — high pretest for stent thrombosis; arc interval staging applies.
Other reasons your team may use this plan: angiographic in-stent filling defect or timi 0 occlusion at prior-stent segment — definite stent thrombosis per arc; premature dapt cessation (surgery, bleed, non-adherence) + new acs — most common modifiable cause; known cyp2c19 lof allele on clopidogrel + breakthrough event — escalation indication per tailor-pci.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 162-325 mg load → 81 mg | PO chewed | load once → 81 mg daily lifelong | Universal — ACC/AHA 2025 Class I; lifelong post-PCI |
| ticagrelor | 180 mg load → 90 mg BID (consider 60 mg BID after 12 mo per PEGASUS for extended DAPT) | PO | BID × 12-30 mo per DAPT score / PEGASUS | Preferred escalation per TAILOR-PCI logic; PLATO PMID 19717846 net benefit; PEGASUS PMID 25773268 supports 60 mg BID 1-3 y post-MI extended phase |
| prasugrel | 60 mg load → 10 mg daily (5 mg daily if wt <60 kg) | PO | daily × 12-30 mo per DAPT score | TRITON-TIMI 38 PMID 17982182 — superior to clopidogrel post-PCI; ISAR-REACT 5 PMID 31475799 — non-inferior to ticagrelor; CONTRAINDICATED prior stroke/TIA, age >75, wt <60 |
| cangrelor | 30 µg/kg IV bolus + 4 µg/kg/min infusion | IV | continuous during PCI then bridge to oral P2Y12 | CHAMPION-PHOENIX PMID 23394482 — IV P2Y12 useful when oral absorption unreliable or bridge decision pending; rapid onset/offset |
| unfractionated_heparin | 60-70 U/kg IV bolus + infusion (titrate ACT 250-300 during PCI) | IV | continuous through PCI | ACC/AHA 2025 Class I peri-PCI; reversible; preferred over enoxaparin in emergent re-cath setting |
| eptifibatide | 180 µg/kg IV bolus × 2 (10 min apart) + 2 µg/kg/min infusion (renal dose-adjust) | IV | 12-18 h post-PCI | Selective use per ACC/AHA 2025 Class IIb; ESPRIT/EARLY-ACS data; bleed risk significant — reserve for high-burden thrombus or no-reflow |
| atorvastatin | 80 mg | PO | once daily | PROVE-IT PMID 15007110; pleiotropic + plaque-stabilising effect particularly relevant in late/very-late stent thrombosis with neoatherosclerosis |
Plan: Stent-thrombosis escalated antithrombotic phenotype — escalates parent cardio.nstemi.core.v1 P2Y12 selection + adds selective IIb/IIIa + IVUS-guided PCI
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Extended DAPT 30 mo (DAPT score ≥2) per Mauri NEJM 2014 OR ticagrelor 60 mg BID per PEGASUS PMID 25773268 if very-late thrombosis; CYP2C19 testing if not done (TAILOR-PCI); cardiac rehab; aggressive lipid + adherence reinforcement; consider IVUS-guided PCI for any future intervention
Guideline: 2025 ACC/AHA Guideline for ACS (Rao) — stent-thrombosis section; ESC 2023 ACS (Byrne, PMID 37622670); ARC stent thrombosis definitions (Cutlip, PMID 17470709)