In addition, the rate of stent thrombosis reported at 30 days was significantly lower with prasug- The loading dose of clopidogrel in TRITON-TIMI 38, which rarely was administered before coronary angiog- raphy and was limited to 300 mg, may have contributed to differences in efficacy and safety between treatment groups.262 The benefits of prasugrel relative to clopidogrel in STEMI must be weighed against the increase in the risk of bleeding associated with its use. Prasugrel should not be administered to patients with a history of stroke or transient ischemic attack and was not shown to be beneficial in patients 75 years of age or patients who weigh <60 kg.260 In TRITON-TIMI 38, interaction testing for efficacy and safety showed no signifi- cant difference in bleeding risk across the spectrum of ACS. Prasugrel may be best suited for younger patients with diabe- tes mellitus or large areas of myocardium at risk, who are also at low bleeding risk, have the ability to continue a regimen of DAPT, and have no anticipation of surgery over the subse- quent 1 year. The package insert for prasugrel suggests that a lower maintenance dose of 5 mg daily might be considered for patients at high risk of bleeding, though this dose has not been Ticagrelor is a reversible, nonthienopyridine P2Y12 receptor antagonist that does not require metabolic conversion to active drug. The PLATO (Platelet Inhibition and Patient Outcomes) study compared ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) with clopidogrel (300- or 600-mg loading dose, 75 mg daily thereafter) for the prevention of cardiovas- cular events in 18624 patients with ACS, of whom 35% had Among the 7544 patients enrolled with ST eleva- tion or LBBB who underwent primary PCI, findings were consistent with the overall trial results. 