Which antithrombotic regimen is recommended for a patient undergoing primary PCI for STEMI based on current AHA/ACC/ESC guidelines?

• A Aspirin + warfarin for 12 months
• B Aspirin alone for 1 year
• C Clopidogrel monotherapy without aspirin
• D Aspirin + prasugrel or ticagrelor (preferred P2Y12 inhibitors over clopidogrel) ✓

Explanation

For primary PCI in STEMI, dual antiplatelet therapy (DAPT) with aspirin plus a potent P2Y12 inhibitor (prasugrel or ticagrelor) is preferred over aspirin + clopidogrel, based on TRITON-TIMI 38 (prasugrel) and PLATO (ticagrelor) trials showing reduced major adverse cardiovascular events. DAPT is maintained for 12 months post-ACS unless high bleeding risk warrants de-escalation. Warfarin-based strategies are reserved for specific indications (e.g., AF, LV thrombus). Monotherapy is insufficient acutely.

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

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Written and medically reviewed by the StethoPrep medical team.