Antiplatelet Therapy of STEMI
Aspirin 162–325 mg × 1 (crushed/chewed) then 81 mg qd
23% ↓ in death (Lancet 1988;ii:349) Should not be stopped if CABG required
P2Y12 inhibitor
Give ASAP (do not wait for angio) b/c onset inhib delayed in STEMI Pts Ticagrelor or prasugrel (if PCI) as detailed above Clopidogrel: 600 mg pre-PCI; 300 mg if lysis (no LD if >75 y) → 75 mg qd PCI: prasugrel and ticagrelor ↓ CV events c/w clopi (Lancet 2009;373:723 & Circ 2010;122:2131) Prehospital ticagrelor may be safe & ? ↓ rate of stent thrombosis (NEJM 2014;371:1016) Lysis: clopidogrel 41% ↑ in patency, 7% ↓ mort, no Δ major bleed or ICH (NEJM 2005;352:1179; Lancet 2005;366:1607); no data for pras or ticag w/ lytic
GP IIb/IIIa inhibitors
abciximab, eptifibatide, tirofiban Lysis: no indication (Lancet 2001;357:1905) Peri-PCI: 60% ↓ D/MI/UR (NEJM 2001;344:1895) (Circ 2013;127:529; NEJM 2021;384:452; JAMA 2021;325:1545)