Table 3. Adjunctive Antithrombotic Therapy to Support
Reperfusion With Primary PCI (continued)
COR
Anticoagulant therapy
• UFH:
▶▶ With GP IIb/IIIa receptor antagonist planned:
50-70-U/kg IV bolus to achieve therapeutic activated
clotting time (ACT)c
▶▶ With no GP IIb/IIIa receptor antagonist planned:
70-100-U/kg bolus to achieve therapeutic ACTd
• Bivalirudin: 0.75-mg/kg IV bolus, then 1.75 mg/kg/h
infusion with or without prior treatment with UFH. An
additional bolus of 0.3 mg/kg may be given if needed.
▶▶ Reduce infusion to 1 mg/kg/h with estimated
CrCl <30 mL/min
▶▶ Preferred over UFH with GP IIb/IIIa receptor
antagonist in patients at high risk of bleeding
• Fondaparinux: not recommended as sole anticoagulant for
primary PCI
LOE
I
C
I
C
I
B
IIa
B
III: Harm
B
The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily.
Balloon angioplasty without stent placement may be used in selected patients. It might be
reasonable to provide P2Y12 inhibitor therapy to patients with STEMI undergoing balloon
angioplasty alone according to the recommendations listed for BMS. (C).
c
The recommended ACT with planned GP IIb/IIIa receptor antagonist treatment is 200-250 s.
d
The recommended ACT with no planned GP IIb/IIIa receptor antagonist treatment is 250-300 s
(HemoTec device) or 300-350 s (Hemochron device).
a
b
7
