A 62-year-old STEMI patient on edoxaban; what should be given immediately as part of early management?

• A. Aspirin with ticagrelor
• B. Aspirin with clopidogrel
• C. Warfarin
• D. Aspirin with clopidogrel

Answer: (D)

In STEMI, the immediate antithrombotic plan is dual antiplatelet therapy to prevent further platelet clumping and thrombus growth. When a patient is already on a DOAC like edoxaban, adding another anticoagulant or using a very potent P2Y12 inhibitor raises bleeding risk significantly. Therefore, the safest and most appropriate immediate choice is aspirin combined with clopidogrel. This provides essential antiplatelet effect to address the ACS while keeping bleeding risk more manageable in the context of ongoing DOAC therapy. Warfarin would add systemic anticoagulation and isn’t used acutely here, and ticagrelor would increase bleeding risk more than is prudent with a DOAC.