Treatment
16
Table 11. Myocardial Revascularization (cont'd)
Recommendations
COR LOE
Bivalirudin is useful as an anticoagulant with or without prior
treatment with UFH in patients with NSTE-ACS undergoing PCI.
I B
An additional dose of 0.3 mg/kg IV enoxaparin should be
administered at the time of PCI to patients with NSTE-ACS
who have received fewer than 2 therapeutic subcutaneous doses
(e.g., 1 mg/kg SC) or received the last subcutaneous enoxaparin dose
8-12 h before PCI.
I B
If PCI is performed while the patient is on fondaparinux, an
additional 85 IU/kg of UFH should be given intravenously
immediately before PCI because of the risk of catheter thrombosis
(60 IU/kg IV if a GPI used with UFH dosing based on the target-
activated clotting time).
I B
In patients with NSTE-ACS, anticoagulant therapy should be
discontinued aer PCI unless there is a compelling reason to
continue such therapy.
I C
In patients with NSTE-ACS undergoing PCI who are at high
risk of bleeding, it is reasonable to use bivalirudin monotherapy in
preference to the combination of UFH and a GP IIb/IIIa receptor
antagonist.
IIa B
Performance of PCI with enoxaparin may be reasonable in patients
treated with upstream subcutaneous enoxaparin for NSTE-ACS.
IIb B
Fondaparinux should NOT be used as the sole anticoagulant to
support PCI in patients with NSTE-ACS due to an increased risk of
catheter thrombosis.
III:
Harm
B
