Adjunctive Antithrombotic Therapy With Fibrinolysis (Table 7)
Antiplatelet Therapy
ÎÎAspirin (162-325 mg loading dose) and clopidogrel (300 mg loading
dose for patients ≤75 years of age, 75 mg dose for patients >75 years
of age) should be administered to patients with STEMI who receive
fibrinolytic therapy. (I-A)
ÎÎAspirin should be continued indefinitely (I-A), and clopidogrel (75 mg
daily) should be continued for ≥14 days (I-A) and up to 1 year (I-C) in
patients with STEMI who receive fibrinolytic therapy.
ÎÎIt is reasonable to use aspirin 81 mg per day in preference to higher
maintenance doses after fibrinolytic therapy. (IIa-B)
Anticoagulant Therapy
ÎÎPatients with STEMI undergoing reperfusion with fibrinolytic therapy
should receive anticoagulant therapy for a minimum of 48 hours and
preferably for the duration of the index hospitalization, up to 8 days or
until revascularization if performed. (I-A)
Recommended regimens include:
• UFH administered as a weight-adjusted intravenous bolus and infusion to obtain
an activated partial thromboplastin time (aPTT) of 1.5-2.0 times control, for 48
hours or until revascularization. (I-C)
or
• Enoxaparin administered according to age, weight, and CrCl, given as an
intravenous bolus, followed in 15 minutes by subcutaneous injection for the
duration of the index hospitalization, up to 8 days or until revascularization. (I-A)
or
• Fondaparinux administered with initial intravenous dose, followed in 24 hours
by daily subcutaneous injections if the estimated CrCl is >30 mL/min, for the
duration of the index hospitalization, up to 8 days or until revascularization. (I-B)
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