Transitioning From Cangrelor to Oral P2Y12 Inhibitors
A 67-year-old male patient with a history of hypertension and type 2 diabetes mellitus presents to the emergency department with sudden onset chest pain that began while he was mowing his lawn. His only home medications are hydrochlorothiazide 25 mg taken once daily and metformin 500 mg taken twice daily. Upon arrival to the emergency department, his blood pressure is 135/88 mmHg, and his heart rate is 95 bpm. He appears to be in mild discomfort, but his physical exam is otherwise unremarkable. His electrocardiogram shows sinus rhythm with anterior ST segment depressions, and his initial troponin I level is 1.2 ng/ml. His chest pain persists despite two doses of sublingual nitroglycerin, so he is started on a nitroglycerin infusion, and the decision is made to proceed with a coronary angiogram. The patient receives 325 mg of chewable aspirin and is transferred to the cardiac catheterization laboratory. Coronary angiography reveals a 90% occlusion of his mid left anterior descending that is associated with thrombus. He is started on a cangrelor infusion, and a drug-eluting stent is then placed across the lesion, resulting in normal flow. His chest pain subsequently resolves. The patient tolerates the procedure well, and there are no immediate complications. The cangrelor is discontinued after a total infusion time of 2 hours.
In addition to a daily dose of 81 mg of aspirin, which of the following is an acceptable strategy for oral antiplatelet therapy?