Which antiplatelet therapy is standard in PCI?

• A. Aspirin alone
• B. Aspirin plus a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) with loading doses
• C. Clopidogrel alone
• D. No antiplatelet therapy

Answer: (B)

Dual antiplatelet therapy is standard in PCI because both aspirin and a P2Y12 inhibitor work together to prevent clotting on the newly placed stent. Aspirin reduces platelet activation by inhibiting thromboxane A2, while a P2Y12 inhibitor blocks the ADP receptor on platelets, preventing amplification of the activation signal. Using them together provides rapid and robust platelet inhibition, which is crucial during and immediately after stent deployment to prevent stent thrombosis and myocardial infarction. That rapid protection is achieved with loading doses of the P2Y12 inhibitor (and often a loading dose of aspirin as well), ensuring effective inhibition as soon as the device is in place.

Aspirin alone wouldn’t fully prevent platelet aggregation, and clopidogrel alone lacks the rapid onset provided by a loading dose of a P2Y12 inhibitor. No antiplatelet therapy would leave the patient extremely vulnerable to thrombotic events after PCI.