A 55-year-old man is diagnosed with NSTEMI (troponin I 4.2 ng/mL, TIMI risk score 5). Which antiplatelet strategy, in addition to aspirin, is preferred per current guidelines for patients managed invasively?
- A Clopidogrel
- B Prasugrel initiated before coronary anatomy is known
- C Ticagrelor ✓
- D Vorapaxar
Correct answer: C. Ticagrelor
Explanation
Ticagrelor (180 mg loading, then 90 mg twice daily) is preferred over clopidogrel for ACS patients managed invasively, based on the PLATO trial showing superior reduction in cardiovascular death, MI, and stroke without significant increase in CABG-related bleeding. Prasugrel should not be given before coronary anatomy is known (ACCOAST trial harm). Vorapaxar is a PAR-1 inhibitor not first-line in ACS. Clopidogrel remains an alternative when ticagrelor/prasugrel are contraindicated.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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