American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the dual antiplatelet therapy (DAPT) of choice for STEMI patients receiving thrombolysis?

1. Aspirin and clopidogrel

2. Aspirin and dipyridamole

3. Clopidogrel and ticagrelor

4. Aspirin and warfarin

The correct answer is: Aspirin and clopidogrel

In the context of STEMI (ST-Elevation Myocardial Infarction) patients receiving thrombolysis, the standard and most recommended dual antiplatelet therapy (DAPT) involves the use of aspirin in combination with clopidogrel. This combination has been extensively studied and is supported by clinical guidelines due to its effectiveness in reducing the risk of major cardiovascular events, such as recurrent myocardial infarction, stent thrombosis, and death, in patients undergoing thrombolytic therapy. Aspirin functions by irreversibly inhibiting cyclooxygenase-1 (COX-1), leading to decreased production of thromboxane A2, which is a potent platelet aggregator. Clopidogrel, on the other hand, works by inhibiting the P2Y12 subtype of ADP receptor on platelets, which is crucial for platelet activation and aggregation. The synergistic effect of these two medications enhances antiplatelet activity, thereby improving patient outcomes significantly. The other combinations mentioned do not meet the specific needs of patients undergoing thrombolysis for STEMI. For instance, while ticagrelor is a more potent antiplatelet agent compared to clopidogrel, its combination with aspirin is generally considered in non