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ACS — RACP Adult Medicine MCQ

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ModerateCardiologyACSRACP Adult Medicine

A 72-year-old man with chronic stable angina and a recent NSTEMI is commenced on ticagrelor. Which of the following is a recognised contraindication to ticagrelor that does NOT apply to clopidogrel?

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Correct answer: D — Use of strong CYP3A4 inhibitors

Ticagrelor is metabolised by CYP3A4, and concomitant use with strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin) or inducers (e.g. rifampicin) is contraindicated. This does not apply to clopidogrel, which is metabolised by CYP2C19. History of intracranial haemorrhage and active bleeding are contraindications to both agents.

Reference: AMH – 2025 – Antiplatelet agents; eTG – 2025 – Cardiovascular