What combination therapy should be given to a patient with STEMI undergoing fibrinolytic treatment?

In the context of a patient with ST-Elevation Myocardial Infarction (STEMI) undergoing fibrinolytic treatment, the recommended combination therapy involves the use of aspirin and clopidogrel. This combination is supported by guidelines due to its synergistic effect in preventing further platelet aggregation and reducing the risk of subsequent thrombotic events.

Aspirin plays a critical role as an antiplatelet agent that inhibits cyclooxygenase-1 (COX-1), decreasing the production of thromboxane A2, a potent platelet activator. Clopidogrel, a thienopyridine, functions as an adenosine diphosphate (ADP) receptor inhibitor that further prevents platelet activation and aggregation. The use of both agents together provides a comprehensive approach to managing the acute coronary occlusion caused by STEMI.

The administration of this dual antiplatelet therapy post-fibrinolysis is associated with improved outcomes, including a reduction in the risk of death and recurrent myocardial infarction when compared to aspirin alone. It ensures that while the fibrinolytic agent works to dissolve the thrombus, the platelet activity is effectively suppressed to prevent re-occlusion.

While other combinations, such as aspirin with tic