Continuation of a P2Y12 inhibitor beyond 1 year may be considered in patients undergoing DES place- ment. (Level of Evidence: C) Class III: Harm 1. Prasugrel should not be administered to patients with a history of prior stroke or transient ischemic (Level of Evidence: B) Although the minimum effective aspirin dose in the setting of PCI for STEMI has not been established prospectively, the writ- ing committee recommends that an empiric dose of 325 mg be given as early as possible before PCI and a maintenance dose continued indefinitely thereafter. It is the consensus of the writ- among patients who receive a stent during primary PCI. This The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily. recommendation is based on evidence of an increased risk of bleeding in most studies comparing higher- with lower-dose as well as the absence of data from RCTs demonstrating superior efficacy of higher aspirin doses in this setting. However, because the CURRENT-OASIS 7 (Clopi- dogrel Optimal Loading Dose Usage to Reduce Recurrent Events Organization to Assess Strategies in Ischemic Syn- dromes) trial did not report differences in either efficacy or safety in patients with STEMI randomized to 81 mg versus 325 mg of aspirin, the committee did not think that the evi- dence favoring 81 mg over higher dosages was sufficiently conclusive to merit a Class I recommendation.253 Loading doses of P2Y12 inhibitors are provided before or at the time of primary PCI. These agents are continued in a maintenance dose for 1 year after PCI with a stent (BMS or DES) in the absence of bleeding. 