Brilique

DAPT was initiated in all but three patients. The loading doses of 500 mg acetylic salicylic acid (ASA) and either 180 mg ticagrelor (Brilique, AstraZeneca, Hamburg, Germany) or 30 mg prasugrel (Efient, Orifarm, Leverkusen, Germany) or 300 mg clopidogrel (Plavix, 1A Pharma, Holzkirchen, Germany) were administered 24 h prior to the intervention. In emergency cases, however, patients received a bolus of 500 mg ASA intravenously (i.v.) at the beginning of the intervention. In addition, a bolus of body-weight adapted Eptifibatide i.v. (Integrilin, 180 µg/kg; GlaxoSmithKline, Ireland) was given to bridge the duration of the intervention before the second anti-platelet agent was amended orally, immediately after the intervention.
DAPT was then continued as a combination of 100 mg ASA with either ticagrelor 180 mg (given in two single doses of 90 mg 12 h apart) or 10 mg prasugrel or 75 mg clopidogrel daily for at least 12 months, followed by a life-long monotherapy with ASA.
In three cases, a decision was made to keep the patients on SAPT only. The rationale for SAPT in these cases, which demanded a less aggressive inhibition of thrombocyte function, was a preexisting anticoagulation due to cardiologic indication in two patients who remained on ASA only. In the third case, patient anti-platelet therapy with prasugrel only was administered with regards to imminent renal transplantation.

Preceding ICA stent implantation, all patients received a single body-weight-adjusted intravenous bolus of Eptifibatide (135 mcg/kg body weight; Integrilin, GlaxoSmithKline). In addition, all patients received 500 mg acetylsalicylic acid (ASA; Aspirin i.v. 500 mg, Bayer Vital) intravenously and either 180 mg ticagrelor (Brilique, AstraZeneca), 40 mg prasugrel (Efient, Daiichi Sankyo), or 300 mg clopidogrel (Plavix, Sanofi-Aventis) via a nasogastric tube.
For medicinal treatment, 1 × 100 mg ASA and 2 × 90 mg ticagrelor or 1 × 10 mg prasugrel or 1 × 75 mg clopidogrel were administered from day 1 after treatment for 1 year. Thereafter 1 × 100 mg ASA was prescribed for life. Until 2015, the combination with clopidogrel was the standard, and we tested for sufficient inhibition within 12 h after stent implantation using a platelet function analyzer or multiplate analyzer (Roche Diagnostics, Mannheim, Germany) and VerifyNow® (Accriva, San Diego, CA, USA). Until 2015, clopidogrel malresponders were switched to ticagrelor. In cases of intolerance to ticagrelor (e.g. shortness of breath), we switched to prasugrel.