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Table 15. Dosing of Parenteral Anticoagulants During PCI
Drug
a
In Patients Who Have Received
Prior Anticoagulant Therapy
In Patients Who Have
Not Received
Prior Anticoagulant
Therapy
Enoxaparin • For prior treatment with enoxaparin, if
last SC dose was administered 8-12 h
earlier or if <2 therapeutic SC doses of
enoxaparin have been administered, an
IV dose of enoxaparin 0.3 mg/kg should
be given
• If the last SC dose was administered
within prior 8 h, no additional
enoxaparin should be given
• 0.5-0.75 mg/kg IV
loading dose
Bivalirudin • For patients who have received UFH,
wait 30 min, then give 0.75 mg/kg IV
loading dose, then 1.75 mg/kg/h IV
infusion
• For patients already receiving bivalirudin
infusion, give additional loading dose
0.5 mg/kg and increase infusion to 1.75
mg/kg/h during PCI
• 0.75 mg/kg loading
dose, 1.75 mg/kg/h IV
infusion
Fondaparinux • For prior treatment with fondaparinux,
administer additional IV treatment with
anticoagulant possessing anti-IIa activity,
considering whether GPI receptor
antagonists have been administered
N/A
UFH • IV GPI planned: additional UFH as
needed (e.g., 2,000-5,000 U) to achieve
ACT of 200-250 s
• No IV GPI planned: additional UFH
as needed (e.g., 2,000-5,000 U) to
achieve ACT of 250-300 s for HemoTec,
300-350 s for Hemochron
• IV GPI planned:
50-70 U/kg loading
dose to achieve ACT
of 200-250 s
• No IV GPI planned:
70-100 U/kg loading
dose to achieve target
ACT of 250-300 s for
HemoTec, 300-350 s
for Hemochron
a
Drugs presented in order of the COR and then the LOE. When more than one drug exists within the
same LOE, and there are no comparative data, then the drugs are listed alphabetically.
