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STEMI — EECC MCQ

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HardCoronary Artery DiseaseSTEMIEECC

A patient undergoes primary PCI for STEMI and has a previous ischaemic stroke. Which potent P2Y12 inhibitor should be avoided?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: EPrasugrel because previous stroke or TIA is a contraindication

Prasugrel is contraindicated in patients with previous stroke or transient ischaemic attack because of excess intracranial bleeding risk. Ticagrelor may be an alternative when otherwise appropriate, while clopidogrel is used when potent therapy is contraindicated or unsuitable. Choice also considers age, weight, bleeding, oral absorption and anticoagulation. The original default-regimen item was basic and failed to test the important patient characteristic that changes the preferred P2Y12 inhibitor. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks and follow-up.

Reference: 2023 ESC Guidelines for acute coronary syndromes. https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/acute-coronary-syndromes/