ÎÎIt may be reasonable to administer intravenous GP IIb/IIIa receptor
antagonist in the precatheterization laboratory setting (eg, ambulance,
emergency department) to patients with STEMI for whom primary PCI
is intended. (IIb-B)
ÎÎIt may be reasonable to administer intracoronary abciximab to
patients with STEMI undergoing primary PCI. (IIb-B)
ÎÎContinuation of a P2Y12 inhibitor beyond 1 year may be considered in
patients undergoing DES placement. (IIb-C)
ÎÎPrasugrel should NOT be administered to patients with a history of
prior stroke or transient ischemic attack. (III-B: Harm)
Anticoagulant Therapy
ÎÎFor patients with STEMI undergoing primary PCI, the following
supportive anticoagulant regimens are recommended:
• UFH, with additional boluses administered as needed to maintain therapeutic
activated clotting time (ACT) levels, taking into account whether a GP IIb/IIIa
receptor antagonist has been administered (I-C) or
• Bivalirudin with or without prior treatment with UFH. (I-B)
ÎÎIn patients with STEMI undergoing PCI who are at high risk of bleeding,
it is reasonable to use bivalirudin monotherapy in preference to the
combination of UFH and a GP IIb/IIIa receptor antagonist. (IIa-B)
ÎÎFondaparinux should NOT be used as the sole anticoagulant to support
primary PCI because of the risk of catheter thrombosis. (III-B: Harm)
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