Reduction of atherothrombotic events in recent MI, stroke or established peripheral arterial disease; acute coronary syndrome & in patients w/ ST segment elevation acute MI in combination w/ aspirin. Prevention of atherothrombotic & thromboembolic events including stroke in atrial fibrillation in combination w/ aspirin.
Recent MI & stroke, established peripheral arterial disease 75 mg once daily. Acute coronary syndrome (unstable angina or non-Q-wave MI) Initially 300 mg single loading dose then 75 mg once daily in combination w/ aspirin 75-325 mg daily. ST segment elevation acute MI 75 mg once daily w/ or w/o loading dose in combination w/ aspirin & w/ or w/o thrombolytics. Prevention of atherothrombotic & thromboembolic events in atrial fibrillation 75 mg once daily in combination w/ aspirin 75-100 mg daily. CYP2C19 poor metabolizers 600 mg loading dose followed by 150 mg once daily.
Discontinue treatment 5-10 days prior to elective surgery. Thrombotic thrombocytopenic purpura. Patients at risk of increased bleeding from trauma, surgery or other pathological conditions; w/ lesions w/ propensity to bleed eg, ulcers. Increased major bleeding in patients w/ recent transient ischaemic attacks or stroke who are at high risk for recurrent ischemic events in combination w/ aspirin. Consider blood cell count determination. Not recommended in concomitant use w/ oral anticoagulants (eg, warfarin). Concomitant use w/ drug-induced lesions. Moderate (CrCl 30-60 mL/min) & severe (CrCl 5-15 mL/min) renal impairment. Not to be used during pregnancy. Lactation.
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