Dual antiplatelet therapy for thrombolytic therapy

For patients with STEMI undergoing thrombolytic therapy, give aspirin plus clopidogrel; use:

aspirin 300 mg orally, chewed or dissolved before swallowing, for the first dose, then 100 to 150 mg daily1 aspirin aspirin aspirin

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clopidogrel 300 mg orally, for the first dose, then 75 mg daily. clopidogrel clopidogrel clopidogrel

Clopidogrel is the only P2Y12 inhibitor suitable for use with thrombolytic therapy. However, it is reasonable to switch treatment to ticagrelor after the initial loading dose of clopidogrel if desired; this should be considered in patients at high risk of recurrent events. If switching from clopidogrel to ticagrelor, use:

ticagrelor 180 mg orally, for the first dose, given 12 hours after the last dose of clopidogrel, then 90 mg twice dailyBerwanger, 2019Bonaca, 2015. ticagrelor ticagrelor ticagrelor

1 If the patient has already received a 300 mg dose of aspirin as initial therapy for acute chest pain of possible cardiac origin, do not repeat this initial 300 mg dose.Return