A 49-year-old STEMI patient not eligible for reperfusion therapy with low bleeding risk; what is the most appropriate medical management to reduce complications?

• A. Aspirin with ticagrelor
• B. Aspirin with clopidogrel
• C. Clopidogrel alone
• D. Ticagrelor alone

Answer: (B)

Dual antiplatelet therapy is used in STEMI to reduce thrombotic complications when reperfusion isn’t pursued. Aspirin gives rapid, irreversible inhibition of platelet aggregation via COX-1, while a P2Y12 inhibitor prevents ADP-mediated platelet activation. In medically managed STEMI, aspirin combined with clopidogrel provides effective, guideline-supported protection with a favorable balance of efficacy and bleeding risk. Clopidogrel is well established for ACS treated without PCI, and although ticagrelor offers greater potency, it carries more bleeding and tolerability concerns, and prasugrel is generally reserved for PCI cases. Therefore, aspirin with clopidogrel best reduces complications in this scenario.