ÎÎPrasugrel, in a 60 mg loading dose, is reasonable once the coronary
anatomy is known in patients who did not receive a previous loading
dose of clopidogrel at the time of administration of a fibrinolytic
agent, but prasugrel should NOT be given sooner than 24 hours
after administration of a fibrin-specific agent or 48 hours after
administration of a non–fibrin-specific agent. (IIa-B)
ÎÎPrasugrel, in a 10 mg daily maintenance dose, is reasonable after PCI.
(IIa-B)
ÎÎ Prasugrel 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 PCI after receiving fibrinolytic
therapy with intravenous UFH, additional boluses of intravenous UFH
should be administered as needed to support the procedure, taking
into account whether GP IIb/IIIa receptor antagonists have been
administered. (I-C)
ÎÎFor patients with STEMI undergoing PCI after receiving fibrinolytic
therapy with enoxaparin, if the last subcutaneous dose was
administered within the prior 8 hours, no additional enoxaparin should
be given. If the last subcutaneous dose was administered between 8
and 12 hours earlier, enoxaparin 0.3 mg/kg IV should be given. (I-B)
ÎÎFondaparinux should NOT be used as the sole anticoagulant to support
PCI. An additional anticoagulant with anti-IIa activity should be
administered because of the risk of catheter thrombosis. (III-C: Harm)
17
