Which agents are commonly used as P2Y12 inhibitors in ACS?

• A. Clopidogrel, ticagrelor, or prasugrel
• B. Abciximab
• C. Warfarin
• D. Rivaroxaban

Answer: (A)

P2Y12 inhibitors prevent platelet activation by blocking the ADP receptor on platelets, which is a key step in forming a clot during acute coronary syndrome. In ACS management, these drugs are used with aspirin as dual antiplatelet therapy to reduce ischemic events.

The commonly used oral P2Y12 inhibitors are clopidogrel, ticagrelor, and prasugrel. Clopidogrel is a prodrug that requires hepatic activation and can have variable responses. Ticagrelor acts directly and provides rapid, consistent platelet inhibition and is reversible. Prasugrel is also rapidly active and potent but carries increased bleeding risk and specific contraindications in certain patients (e.g., prior stroke or TIA). The choice among them depends on patient factors and risk considerations.

Abciximab is a GP IIb/IIIa inhibitor given IV, not a P2Y12 inhibitor. Warfarin is a vitamin K antagonist anticoagulant, and rivaroxaban is a DOAC that inhibits factor Xa; neither blocks the P2Y12 receptor on platelets.