Which combination of medications is common for a patient with a history of ACS and renal insufficiency at discharge?

Aspirin, ticagrelor, and a mineralocorticoid receptor antagonist represent a common and effective combination for patients with a history of acute coronary syndrome (ACS) and renal insufficiency at discharge. Aspirin serves as an antiplatelet agent, which is crucial in preventing further thrombotic events after ACS. Ticagrelor, another antiplatelet medication, is often preferred in this setting due to its ability to provide more potent platelet inhibition compared to older agents, especially in patients with higher risks or those who have undergone more complex revascularization procedures.

The inclusion of a mineralocorticoid receptor antagonist (MRA), such as spironolactone or eplerenone, is particularly relevant in the context of heart failure and reduced renal function. These medications help to mitigate cardiac remodeling, reduce mortality, and offer renoprotective benefits, particularly in patients with left ventricular dysfunction, which is not uncommon after an ACS event.

This combination, while considering the balance between benefits and risks (especially in the context of renal insufficiency), aligns with current guidelines that advocate for the use of dual antiplatelet therapy following ACS, paired with an MRA in eligible patients.

Other combinations may lack