During emergent reperfusion therapy for STEMI with PCI within 90 minutes, which antiplatelet strategy is recommended?

• A. Aspirin alone
• B. Aspirin and a P2Y12 inhibitor per protocol
• C. P2Y12 inhibitor alone
• D. Anticoagulation with heparin without antiplatelets

Answer: (B)

In emergent STEMI treated with PCI within 90 minutes, the goal is rapid and reliable platelet inhibition to prevent thrombus formation around the stent. Aspirin provides immediate, irreversible COX-1 inhibition, lowering thromboxane A2 and platelet activation. A P2Y12 inhibitor blocks ADP-induced platelet activation, offering potent, synergistic antiplatelet effect during PCI. Giving aspirin now and loading with a P2Y12 inhibitor per protocol ensures both pathways of platelet activation are suppressed, which is essential to reduce stent thrombosis and reinfarction risk. Using aspirin alone misses the ADP pathway, and a P2Y12 inhibitor alone misses the COX-1–mediated route; anticoagulation with heparin without antiplatelets does not provide sufficient antiplatelet protection.