There is a recommended duration of therapy for all post-PCI patients receiving a DES. Contraindicated for use in patients with prior history of TIA or stroke. Period of withdrawal before surgery should be at least 7 d. (For full explanations, see footnote.) Ticagrelor Patients who are already receiving clopidogrel should receive a loading dose of ticagrelor LD of 180 mg orally (Class I, LOE: B) MD of 90 mg orally twice daily (Class I, LOE: B) The recommended maintenance dose of ASA to be used with ticagrelor is 81 mg daily. Ticagrelor s benefits were observed irrespective of prior therapy with clopidogrel (47% of patients in PLATO received clopidogrel at the time of randomization). Period of withdrawal before surgery should be at least 5 d. Issues of patient compliance may be especially important with twice-daily dosing regimen. Ticagrelor increases the risk of fatal ICH compared with clopidogrel and should be avoided in those with a prior history of ICH. Until further data become available, it seems prudent to weigh the possible increased risk of intracranial bleeding when considering the addition of ticagrelor to aspirin in patients with prior stroke or TIA. (Continued) Appendix 3. Continued Drug* During PCI Comments All Patients to Receive ASA Patient Received Initial Medical Treatment (With a P2Y12 Receptor Inhibitor) Patient Did Not Receive Initial Medical Treatment (With a P2Y12 Receptor Inhibitor) Parenteral Anticoagulants Bivalirudin For patients who have received UFH, wait 30 min, then give 0.75 mg/kg bolus, then 1.75 mg/kg per h infusion (Class I, LOE: B) 0.75 mg/kg bolus, 1.75 mg/kg per h infusion Bivalirudin may be used to support PCI and UA/NSTEMI with or without previously administered UFH with the addition of 600 mg of clopidogrel. In UA/NSTEMI patients undergoing PCI who are at high risk of bleeding, bivalirudin anticoagulation is reasonable. 