Which medication is contraindicated in NSTEMI patients with a history of stroke?

Which medication is contraindicated in NSTEMI patients with a history of stroke?

• A. Prasugrel
• B. Clopidogrel
• C. Ticagrelor
• D. Aspirin

Answer: (C)

The key idea is how a patient’s prior stroke or TIA affects antiplatelet choice in NSTEMI. Prasugrel carries a markedly higher risk of intracranial bleeding in people with a history of stroke or TIA, so it is contraindicated in that subgroup. Because of this, you avoid prasugrel for NSTEMI patients who’ve had a stroke and instead consider other agents like clopidogrel or ticagrelor, with aspirin as standard therapy unless there’s a specific contraindication. Clopidogrel and ticagrelor do not have an absolute contraindication for prior stroke, though bleeding risk must always be weighed.

The key idea is how a patient’s prior stroke or TIA affects antiplatelet choice in NSTEMI. Prasugrel carries a markedly higher risk of intracranial bleeding in people with a history of stroke or TIA, so it is contraindicated in that subgroup. Because of this, you avoid prasugrel for NSTEMI patients who’ve had a stroke and instead consider other agents like clopidogrel or ticagrelor, with aspirin as standard therapy unless there’s a specific contraindication. Clopidogrel and ticagrelor do not have an absolute contraindication for prior stroke, though bleeding risk must always be weighed.