Dynamic Duo
According to the 2025 ACC/AHA ACS guidelines, what is the recommended default duration of dual antiplatelet therapy (DAPT) for patients presenting with ACS?
12 months of DAPT
In patients with ACS who are considered at high bleeding risk following PCI, what is the minimum recommended duration of DAPT before transition to monotherapy?
at least 1 month
Which prior medical history represents an absolute contraindication to the use of prasugrel in patients with ACS?
History of stroke or transient ischemic attack (TIA)
What intensity of statin therapy is recommended for all patients following an ACS event, barring contraindications?
High-intensity statin therapy
Which P2Y12 inhibitor is only indicated for patients who undergo a percutaneous coronary intervention (PCI)?
Prasugrel
Which P2Y₁₂ inhibitors are preferred for most patients with ACS when no contraindications are present?
Ticagrelor (Brillinta) and prasugrel (Effient)
What antiplatelet strategy is recommended in the 2025 guidelines to reduce bleeding risk following an initial period of DAPT with ticagrelor?
Transition from DAPT to ticagrelor monotherapy
Which medication class is recommended to reduce gastrointestinal bleeding risk in patients receiving DAPT?
Proton Pump Inhibitors
What LDL-C target range is recommended in the 2025 ACS guidelines for secondary prevention?
55 - 69mg/dL
Name one P2Y12 inhibitor that produces irreversible platelet inhibition for the lifespan of the platelet.
clopidogrel (Plavix) and prasugrel (Effient)
For patients with NSTEMI managed conservatively without PCI, what regimen is preferred in the ACS 2025 Guidelines?
A. Aspirin plus ticagrelor
B. Aspirin plus clopidogrel
C. Aspirin only
D. DAPT is not indicated for this population
A. Aspirin plus ticagrelor
What patient-specific risks drive the guideline recommendation to minimize the duration of triple antithrombotic therapy in ACS?
major and life-threatening bleeding
Name a proton pump inhibitor that should be avoided in patients receiving clopidogrel due to CYP2C19-mediated drug interactions?
Omeprazole or esomeprazole
For patients with ACS whose LDL-C remains ≥70 mg/dL on maximally tolerated statin therapy, what is the next step in therapy?
non-statin lipid therapy e.g. ezetimibe
Which oral antiplatelet agent carries a boxed warning for diminished effectiveness in poor metabolizers?
clopidogrel (Plavix)
Which antiplatelet agent is contraindicated in patients with NSAID or salicylate allergy?
Aspirin
In ACS patients who also require a DOAC, which agents are typically continued after a minimum duration of triple antithrombotic therapy?
P2Y12 inhibitor and DOAC
Which P2Y₁₂ inhibitors are not affected by concomitant proton pump inhibitor therapy?
Ticagrelor (Brillinta) and prasugrel (Effient)
What lipid-lowering strategy is recommended for ACS patients who are unable to tolerate statin therapy?
Non-statin lipid-lowering therapy (e.g., ezetimibe)
A patient receiving dual antiplatelet therapy reports shortness of breath without signs of heart failure. Which antiplatelet agent is most likely responsible?
Ticagrelor (Brillinta)
Under what clinical circumstances is clopidogrel an appropriate choice in ACS managment?
When ticagrelor or prasugrel are contraindicated, not tolerated, or unavailable
Bleeding risks
What is the recommended duration range for triple antithrombotic therapy (oral anticoagulant plus DAPT) in patients with ACS?
1 to 4 weeks
Why does clopidogrel have greater interpatient variability in antiplatelet response compared to ticagrelor or prasugrel?
Clopidogrel is a prodrug requiring CYP2C19 metabolic activation
In very high-risk patients, what LDL-C threshold may be reasonably targeted according to the 2025 guidelines?
less than 55 mg/dL
How should lipid-lowering therapy be adjusted for a patient with prior myocardial infarction who is taking atorvastatin 20 mg daily and has an LDL-C of 92 mg/dL without adverse effects?
Increase atorvastatin to 40 to 80mg