Treatment
Table 11. Adjunctive Antithrombotic Therapy to Support PCI
After Fibrinolytic Therapy
COR
Antiplatelet therapy
Aspirin
• 162-325 mg loading dose given with fibrinolytic agent
I
(before PCI). (Table 7)
• 81-325 mg daily maintenance dose after PCI (indefinite)
I
IIa
• 81 mg daily is the preferred daily maintenance dose
P2Y12 inhibitors
Loading Doses
For patients who received a loading dose of clopidogrel with fibrinolytic therapy
I
• Continue clopidogrel 75 mg daily without an additional
loading dose
For patients who have not received a loading dose of clopidogrel
I
• If PCI is performed ≤24 h after fibrinolytic therapy:
clopidogrel 300 mg loading dose before or at the time of PCI
I
• If PCI is performed >24 h after fibrinolytic therapy:
clopidogrel 600 mg loading dose before or at the time of PCI
IIa
• If PCI is performed >24 h after treatment with a fibrinspecific agent or >48 h after a non-fibrin-specific agent:
prasugrel 60 mg at the time of PCI
III: Harm
• For patients with prior stroke/TIA: prasugrel
Maintenance Doses and Duration of Therapy
DES placed: Continue therapy for up to 1 y with:
I
• Clopidogrel: 75 mg daily or
IIa
• Prasugrel: 10 mg daily
BMS a placed: Continue therapy for ≥30 d and up to 1 y with:
I
• Clopidogrel: 75 mg daily or
• Prasugrel: 10 mg daily
IIa
Anticoagulant therapy
• Continue UFH through PCI, administering additional IV
I
boluses as needed to maintain therapeutic ACT depending
b
on use of GP IIb/IIIa receptor antagonist
• Continue enoxaparin through PCI:
I
▶▶ No additional drug if last dose was within previous 8 h
▶▶ 0.3-mg/kg IV bolus if last dose was 8-12 h earlier
• Fondaparinux as sole anticoagulant for PCI
III: Harm
LOE
A
A
B
C
C
C
B
B
C
B
C
B
C
B
C
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 after fibrinolysis alone according to the recommendations listed for BMS. (C)
b
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
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