In ACS planned for PCI, which antiplatelet strategy is typically added?

• A. Aspirin alone
• B. Anticoagulation with heparin only
• C. Aspirin plus a P2Y12 inhibitor if PCI planned
• D. No antiplatelet therapy

Answer: (C)

When ACS is being managed with planned PCI, you want dual antiplatelet therapy to prevent platelets from forming clots on the catheters and the stent. Aspirin gives rapid, irreversible inhibition of COX-1, reducing thromboxane A2 and overall platelet activation. A P2Y12 inhibitor blocks the ADP receptor on platelets, preventing another major pathway of platelet activation. Together, they provide stronger and more reliable platelet suppression than either alone, lowering the risk of stent thrombosis and recurrent ischemia around the time of PCI and afterward.

Aspirin alone would leave a significant pathway of platelet activation active, reducing protection during PCI. Anticoagulation with heparin is important during the procedure to prevent clotting in the catheter and vessels, but it’s not an antiplatelet strategy by itself. No antiplatelet therapy would leave the patient at high risk for thrombotic complications.