A patient with NSTEMI is started on dual antiplatelet therapy with aspirin and ticagrelor. He has a prior history of ischaemic stroke 8 months ago. Which statement is most accurate regarding ticagrelor use in this patient?

• A Ticagrelor is absolutely contraindicated after any type of prior stroke
• B Ticagrelor should be replaced by prasugrel, which has a superior safety profile post-stroke
• C Aspirin monotherapy is preferred post-NSTEMI if there is any prior cerebrovascular event
• D Ticagrelor is contraindicated in patients with prior intracranial haemorrhage but can be used after ischaemic stroke ✓

Explanation

Ticagrelor is contraindicated only in patients with prior intracranial haemorrhage (haemorrhagic stroke), not ischaemic stroke. Prasugrel, by contrast, is contraindicated in patients with any prior stroke or TIA due to net clinical harm demonstrated in the TRITON-TIMI 38 trial. After ischaemic stroke, ticagrelor with aspirin (DAPT) is acceptable for ACS management.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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