What is the next step in management for a patient who has experienced a myocardial infarction and is not suitable for reperfusion therapy, having been given aspirin?

The next step in management for a patient who has experienced a myocardial infarction and is not suitable for reperfusion therapy, after having received aspirin, involves the addition of a P2Y12 inhibitor to optimize antiplatelet therapy. Ticagrelor combined with aspirin is often preferred in this scenario due to its safety profile and efficacy.

Ticagrelor is a reversible inhibitor of the P2Y12 receptor and has demonstrated a greater reduction in cardiovascular events compared to some other antiplatelet agents in patients with acute coronary syndrome. This combination enhances the inhibition of platelet aggregation more effectively than aspirin alone, thus improving clinical outcomes.

While clopidogrel and prasugrel are also P2Y12 inhibitors that can be used in conjunction with aspirin, ticagrelor is the most recommended option for patients who cannot undergo reperfusion therapy, considering factors like its rapid onset of action and stronger antiplatelet effect. Warfarin, being an anticoagulant, does not directly address platelet aggregation and is not the treatment of choice in this acute setting.