Optimization of Antiplatelet Therapy in STEMI.

OPINION STATEMENT: Antiplatelet therapy is an essential component of ST elevation myocardial infarction (STEMI) management. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel has previously been the standard of care for STEMI management, but the advent of newer, more potent P2Y12 inhibitors has expanded the options for the management of STEMI. As compared with clopidogrel, these newer P2Y12 agents-such as prasugrel and ticagrelor-allow for further reductions in ischemic end points, without the robust increases in bleeding seen in previous studies of antithrombotic therapies. Understanding the nuances of these newer agents allows optimization of therapy for the individual patient and circumstance. Ultimately, combining these newer therapies, in specific populations, and specific approaches-alternative access strategies (e.g., radial)-may allow us to maximize efficacy and reduce the risk of antiplatelet therapies in treating patients with STEMI.