Which oral antiplatelet therapy is most appropriate for a patient with NSTEMI scheduled for coronary angiography?

The most appropriate choice for a patient with NSTEMI scheduled for coronary angiography is the regimen of aspirin 324 mg now combined with ticagrelor 180 mg administered as a loading dose.

In patients with NSTEMI, early dual antiplatelet therapy is crucial to prevent further thrombotic events, especially when they are awaiting invasive procedures like coronary angiography. Aspirin acts as a foundational therapy in this setting due to its ability to irreversibly inhibit platelet aggregation.

Ticagrelor, on the other hand, is a more potent P2Y12 receptor antagonist compared to clopidogrel, providing a faster onset of action while maintaining more effective platelet inhibition. The loading dose of 180 mg of ticagrelor is the recommended approach in the acute setting to rapidly achieve therapeutic platelet inhibition, which is vital in the high-risk population typically seen in NSTEMI cases.

Administering both 324 mg of aspirin and 180 mg of ticagrelor provides both high-dose aspirin and robust P2Y12 inhibition at the outset, improving the chances of a successful intervention during angiography and reducing the risk of further cardiac events. This dosing strategy aligns well with guidelines that emphasize aggressive antipl