As part of that plan, the manufacturer is mandated to conduct educational outreach programs to alert physicians about the risk of using higher doses of aspirin. Dual antiplatelet therapy with aspirin and either clopi- dogrel or prasugrel has increased the risk of intracranial hemorrhage in several clinical trials and patient populations (especially in those with prior stroke).7,13a,13b,13c In PLATO, the number of patients with prior stroke was small, limiting the power to detect treatment differences in intracranial bleeding in this subgroup.13d Patients with prior stroke or TIA have been excluded from PEGASUS (Prevention of Cardio- vascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of an ongoing trial of ticagrelor versus placebo in addition to aspirin in patients with stable coronary artery disease. Until further data become available, it seems prudent to weigh the possible increased risk of intracranial bleeding when considering the addition of ticagrelor to aspirin in patients with prior stroke or TIA.13f 3.2.3.1.2. Choice of P2Y12 Receptor Inhibitors for PCI in UA/NSTEMI. The writing group cautions that data on the use of prasugrel and ticagrelor come solely from the TRITON TIMI 38 and PLATO trials, respectively, and their use in clinical practice should carefully follow how they were tested in these studies.7,9 Prasugrel was administered only after a decision to proceed to PCI was made, whereas ticagrelor was studied in all-comer patients with UA/NSTEMI, including invasively and medically managed patients. The writing group does not recommend that prasugrel be administered routinely to patients with UA/NSTEMI before angiography, Jneid et al 2012 UA/NSTEMI Focused Update 881 such as in an emergency department, or used in patients with UA/NSTEMI who have not undergone PCI. 