In acute coronary syndrome management, which antiplatelet is universally recommended at presentation?

• A. Clopidogrel
• B. Prasugrel
• C. Ticagrelor
• D. Aspirin

Answer: (D)

Aspirin is the cornerstone of antiplatelet therapy at presentation in acute coronary syndrome because it rapidly and irreversibly inhibits platelet COX-1, which stops thromboxane A2 production and prevents platelet aggregation. This immediate antiplatelet effect reduces mortality and reinfarction across the entire spectrum of ACS (STEMI, NSTEMI, or unstable angina) and works well with any planned reperfusion strategy. The practical approach is a chewable loading dose of 162–325 mg to achieve quick-onset effect, followed by a maintenance dose of about 75–100 mg daily. Other antiplatelets (like clopidogrel, prasugrel, ticagrelor) are added as part of dual antiplatelet therapy but their use is not universal at presentation; their administration depends on factors such as planned PCI, bleeding risk, prior stroke, and contraindications. Thus, aspirin is the universally recommended antiplatelet at presentation in ACS.