What combination of antiplatelet therapy should be recommended for a patient refusing percutaneous coronary intervention for STEMI?

The recommended combination of antiplatelet therapy for a patient refusing percutaneous coronary intervention (PCI) for ST-Elevation Myocardial Infarction (STEMI) is oral aspirin 324 mg and clopidogrel 75 mg. This combination is supported by clinical guidelines that emphasize the importance of dual antiplatelet therapy (DAPT) in managing STEMI, even in patients who do not undergo revascularization procedures like PCI.

Aspirin acts by irreversibly inhibiting cyclooxygenase-1 (COX-1), which reduces the production of thromboxane A2, a potent promoter of platelet aggregation. Clopidogrel, a thienopyridine, further inhibits platelet aggregation by blocking the P2Y12 receptor on the platelet surface, which is crucial for platelet activation and aggregation. This synergistic effect provides a robust strategy to reduce the risk of thrombotic events, such as reinfarction, in patients with STEMI, regardless of their choice to decline PCI.

While higher doses of clopidogrel (like the 300 mg option) have been investigated, they are typically not recommended for routine use outside of specific circumstances, such as in the setting of a prehospital or