A 60-year-old man with asthma and an aspirin allergy requires antiplatelet therapy after a transient ischaemic attack. Which agent is most appropriate?

A 60-year-old man with asthma and an aspirin allergy requires antiplatelet therapy after a transient ischaemic attack. Which agent is most appropriate?

• A. Aspirin
• B. Clopidogrel
• C. Dipyridamole
• D. Warfarin

Answer: (B)

The key idea is choosing an antiplatelet strategy for secondary prevention of a non-cardioembolic TIA when aspirin cannot be used. Since the patient has an aspirin allergy, aspirin-based therapy is not an option. Clopidogrel provides effective platelet inhibition by blocking the P2Y12 receptor, making it a strong alternate antiplatelet choice for aspirin-intolerant patients after TIA. Warfarin is an anticoagulant and carries more bleeding risk; it’s not preferred for non-cardioembolic TIA unless there’s another specific indication (like atrial fibrillation). Dipyridamole alone is less effective than clopidogrel for preventing recurrent events, and combining dipyridamole with aspirin isn’t possible here due to the aspirin allergy. Therefore, clopidogrel is the best choice.

The key idea is choosing an antiplatelet strategy for secondary prevention of a non-cardioembolic TIA when aspirin cannot be used. Since the patient has an aspirin allergy, aspirin-based therapy is not an option. Clopidogrel provides effective platelet inhibition by blocking the P2Y12 receptor, making it a strong alternate antiplatelet choice for aspirin-intolerant patients after TIA. Warfarin is an anticoagulant and carries more bleeding risk; it’s not preferred for non-cardioembolic TIA unless there’s another specific indication (like atrial fibrillation). Dipyridamole alone is less effective than clopidogrel for preventing recurrent events, and combining dipyridamole with aspirin isn’t possible here due to the aspirin allergy. Therefore, clopidogrel is the best choice.