Which antiplatelet agents are used in patients undergoing primary PCI for ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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For patients undergoing primary PCI, a loading dose of 600 mg of clopidogrel, 180 mg of ticagrelor, or 60 mg of prasugrel should be given as early as possible or at the time of primary PCI. A maintenance dose of P2Y12 receptor inhibitors should be continued for at least 1 year for patients who receive a stent, either a BMS or a DES. A daily dose of 75 mg clopidogrel, 90 mg ticagrelor (twice daily), or 10 mg prasugrel is recommended. It is reasonable to discontinue P2Y12 receptor inhibitor agents prior to 1 year for patients who receive a BMS if there is evidence of increased bleeding.

Introducing ticagrelor after myocardial infarction in patients with previous ischemic stroke is associated with lower rates of recurrent ischemic stroke, without an increase in intracranial bleeding. [92]

The use of prasugrel is not recommended for patients with a history of stroke or transient ischemic attack (TIA). [93, 94, 95]

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