A 64-yrs-old woman has had several episodes of transient ischemic attacks (TIAs). Aspirin would be a preferred treatment, but she has a history of severe “aspirin sensitivity” manifests as intense bronchoconstriction. What would be a best suitable alternative to the aspirin? (AIPG 2011)
Patients with a definite aspirin allergy should be treated with a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor).
Clopidogrel at a loading dose of 600 mg (or 300 mg) will result in faster onset of action than the standard 75 mg maintenance dose. Prasugrel is also a P2Y12 inhibitor that is both more potent and has a faster onset of action than clopidogrel.