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

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Study for the Clinical Decision-Making (CDM) Cases Part I Test. Engage with challenging scenarios and questions, complete with hints and explanations for better understanding. Prepare thoroughly for your exam!

Multiple Choice

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

Explanation:
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.

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