Treatment
Table 3. Adjunctive Antithrombotic Therapy to Support
Reperfusion With Primary PCI
COR
6
LOE
Antiplatelet therapy
Aspirin
• 162-325 mg load before procedure
I
B
• 81-325 mg daily maintenance dose (indefinite)a
I
A
IIa
B
• 81 mg daily is the preferred maintenance dosea
P2Y12 inhibitors
Loading Doses
• Clopidogrel: 600 mg as early as possible or at time of PCI or
I
B
• Prasugrel: 60 mg as early as possible or at time of PCI or
I
B
• Ticagrelor: 180 mg as early as possible or at time of PCI
I
B
Maintenance Doses and Duration of Therapy
DES placed: Continue therapy for 1 y with:
I
B
• Clopidogrel: 75 mg daily or
I
B
• Prasugrel: 10 mg daily or
I
B
• Ticagrelor: 90 mg bida
BMS b placed: Continue therapy for 1 y with:
I
B
• Clopidogrel: 75 mg daily or
• Prasugrel: 10 mg daily or
I
B
I
B
• Ticagrelor: 90 mg bida
DES placed:
IIb
C
• Clopidogrel, prasugrel, or ticagrelora continued beyond 1 y
III: Harm B
• Patients with STEMI with prior stroke or TIA: prasugrel
IV GP IIb/IIIa receptor antagonists in conjunction with UFH or bivalirudin in
selected patients
• Abciximab: 0.25-mg/kg IV bolus, then 0.125 mcg/kg/min
IIa
A
(maximum 10 mcg/min)
• Tirofiban: (high-bolus dose): 25-mcg/kg IV bolus, then
0.15 mcg/kg/min
IIa
B
▶▶ In patients with creatinine clearance (CrCl) <30 mL/min,
reduce infusion by 50%
• Eptifibatide: (double bolus): 180-mcg/kg IV bolus, then
2 mcg/kg/min; a second 180-mcg/kg bolus is administered
10 min after the first bolus
IIa
B
▶▶ In patients with CrCl <50 mL/min, reduce infusion
by 50%
▶▶ Avoid in patients on hemodialysis
• Pre-catheterization laboratory administration of IV GP IIb/
IIb
B
IIIa receptor antagonist
• Intracoronary abciximab 0.25-mg/kg bolus
IIb
B
