This determination should balance the risks of stent thrombo- sis and ischemic complications versus bleeding and should be jointly made by the clinician and the patient. Loading and short-term maintenance doses of clopi- dogrel were studied in CURRENT OASIS (Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events Organization to Assess Strategies in Ischemic Syndromes) 7, which demonstrated a potential benefit of higher-dose clopidogrel (600-mg loading dose, 150 mg daily for 6 days, 75 mg daily thereafter) in patients with NSTE-ACS under- going an invasive management strategy.292,391 Although the failed to demonstrate a significant difference in the primary endpoint between the clopidogrel and aspirin groups (4.2% versus 4.4%), the PCI subset (n=17263) showed significant differences in the clopidogrel arm.391 Notably, the higher-dose clopidogrel therapy increased major bleeding in the entire group (2.5% versus 2.0%; P=0.012) and the PCI subgroup (1.1% versus 0.7%; P=0.008). In addition, during the period of several hours required for conversion of clopi- dogrel to its active metabolite, there is reduced effectiveness. However, efficacy is restored following conversion. Patients undergoing PCI who have previously received a loading dose of 300 mg of clopidogrel and are on a 75-mg daily maintenance dose should receive another 300-mg There are no data appropriate for prasugrel because this drug is administered before PCI. For ticagrelor, there are no data on additional loading. 5.1.2.2. GP IIb/IIIa Inhibitors: Recommendations Class I 1. In patients with NSTE-ACS and high-risk features (eg, elevated troponin) who are not adequately pretreated #Patients should receive a loading dose of prasugrel, provided that they were not pretreated with another P2Y12 receptor inhibitor. 