Treatment
Table 7. Adjunctive Antithrombotic Therapy to Support
Reperfusion With Fibrinolytic Therapy
COR
Antiplatelet therapy
Aspirin
• 162-325 mg loading dose
• 81-325 mg daily maintenance dose (indefinite)
• 81 mg daily is the preferred maintenance dose
P2Y12 inhibitors
Clopidogrel
• Age ≤75 y: 300 mg loading dose
▶▶ Followed by 75 mg daily for up to 14 d and up to 1 y in
absence of bleeding
• Age >75 y: no loading dose, give 75 mg
▶▶ Followed by 75 mg daily for up to 14 d and up to1 y in
absence of bleeding
Anticoagulant therapy
UFH
• Weight-based IV bolus and infusion adjusted to obtain an
activated partial thromboplastin time (aPTT) of 1.5-2.0
times control for 48 h or until revascularization. IV bolus
of 60 U/kg (maximum 4000 U) followed by an infusion
of 12 U/kg/h (maximum 1000 U) initially, adjusted to
maintain aPTT at 1.5-2.0 times control (approximately
50-70 s) for 48 h or until revascularization
Enoxaparin
• If age <75 y: 30 mg IV bolus, followed in 15 min by
1 mg/kg subcutaneously every 12 h (maximum 100 mg for
the first 2 doses)
• If age ≥75 y: no bolus, 0.75 mg/kg subcutaneously every 12 h
(maximum 75 mg for the first 2 doses)
• Regardless of age, if creatinine clearance (CrCl) <30 mL/min:
• 1 mg/kg subcutaneously every 24 h
• Duration: For the index hospitalization, ≤8 d or until
revascularization
Fondaparinux
• Initial dose 2.5 mg IV, then 2.5 mg subcutaneously daily
starting the following day, for the index hospitalization
up to 8 d or until revascularization
• Contraindicated if CrCl <30 mL/min
12
LOE
I
I
IIa
A
A
B
I
A
I
A (14 d)
C (≤1 y)
A
A (14 d)
C (≤1 y)
I
I
I
C
I
A
I
B
