Which medication would be least likely to be prescribed after discharge for a patient with acute coronary syndrome?

• A. Alendronic acid
• B. ACE inhibitor
• C. Statin
• D. Antiplatelet agent

Answer: (A)

After acute coronary syndrome, the focus at discharge is on secondary prevention to prevent another event and support heart function. Medications routinely used include antiplatelet therapy to prevent further clotting, high‑intensity statins to stabilize plaques and lower risk, and ACE inhibitors (or ARBs) to protect heart function and remodeling, especially if there is reduced ejection fraction, hypertension, diabetes, or heart failure risk.

An antiplatelet agent is a cornerstone because it directly reduces the chance of another coronary thrombosis. A statin is recommended for all after ACS to lower LDL and provide plaque-stabilizing benefits. An ACE inhibitor is commonly prescribed when there is LV dysfunction or other indications, as it helps prevent adverse remodeling and heart failure progression.

Alendronic acid, on the other hand, is a bisphosphonate used to treat osteoporosis. It isn’t part of routine ACS secondary prevention and would only be used if the patient has osteoporosis or a related fracture risk issue. Therefore, it is the least likely to be prescribed after discharge for an acute coronary syndrome.