Brilinta is like Plavix on steroids and is much more costly and carries a higher risk of bleeding. We use it almost exclusively pre and post PCI (percutaneous  coronary intervention) when a DES (drug eluting stent ) has be deployed. Usually a bolus dose is given prior to an intervention for an emeregent cardiac catherterization to re-establish coronary blood flow in the occluded artery and continued at a minimum of one year with aspirin (DAPT), and aspirin indefinitely thereafter if it has been determined stopping the Plavix/Brilinta is not deleterious. For those identified with fewer risk factors, less concerning coronary artery architecture and expert opinion, some patients following intervention will be transitioned to Plavix with the same recipe as described above post procedure. This is both cost effective and reduces the risk of any major bleeding complications. Of course all of this assumes patient compliance/adherence which is usually dictated by insurance (outside of socialized medicine I assume) and patient motivation.