Which of the following patients should NOT receive prasugrel as part of dual antiplatelet therapy after stenting?
- A A 55-year-old diabetic smoker undergoing primary PCI
- B A 48-year-old woman with STEMI treated with fibrinolysis
- C A 62-year-old man with a documented history of ischaemic stroke ✓
- D A 60-year-old man with NSTEMI planned for angiography
Correct answer: C. A 62-year-old man with a documented history of ischaemic stroke
Explanation
Prior stroke or transient ischaemic attack is an absolute contraindication to prasugrel because the TRITON-TIMI 38 trial showed excessive intracranial haemorrhage in this subgroup. Age above 75 years and body weight below 60 kg are relative cautions requiring dose reduction, not absolute bars. Diabetics and STEMI patients actually derive the greatest ischemic benefit from prasugrel over clopidogrel in trial data.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.