STEMI

Antithrombotic Therapy D. Antiplatelet Therapy 1. Aspirin: > For patients with acute STEMI whether or not they receive fibrinolytic therapy, the ACCP recommends aspirin (160 to 325 mg PO) over no aspirin therapy at initial evaluation by health-care personnel (Grade 1A) followed by indefinite therapy (75 to 162 mg/d PO) (Grade 1A). 2. Clopidogrel: > For patients with acute STEMI, the ACCP recommends clopidogrel in addition to aspirin (Grade 1A). The recommended dosing for clopidogrel is 300 mg PO for patients ≤ 75 years old and 75 mg PO for patients > 75 years old if they receive fibrinolytic agents or no reperfusion therapy, followed by 75 mg/d PO for up to 28 days (Grade 1A). Clopidogrel, 75 mg/day, could be continued beyond 28 days and up to 1 year (Grade 2B). 3. Both: > For patients undergoing primary PCI, the ACCP suggests clopidogrel in addition to aspirin with a recommended initial dosing of at least 300 mg (Grade 1B), followed by 75 mg/d (for duration of therapy). 4. GP IIb/IIIa Inhibitors . . a For patients with acute STEMI, the ACCP recommends against the combination of standard-dose abciximab and half-dose reteplase or tenecteplase with low-dose IV UFH over standard- dose reteplase or tenecteplase (Grade 1B). b For patients with acute STEMI, the ACCP suggests clinicians not use the combination of streptokinase and any GP IIb/IIIa inhibitor (Grade 2B). . c The ACCP suggests administration of a GP IIb/IIIa inhibitor prior to coronary angiography (Grade 2B). The largest number of patients studied in this setting received abciximab, 0.25 mg/kg IV bolus, followed by 0.125 mcg/kg/min (maximum, 10 mcg/ min) for 12 h; recommended dosing for eptifibatide is two 180 mcg IV boluses (10 min apart) followed by 2.0 mcg/kg/min infusion for 12 to 24 h; recommended dosing for tirofiban is 25 mcg/kg IV bolus followed by 0.15 mcg/kg/min for 24 h. d For patients with acute STEMI undergoing primary PCI (with or without stenting), the ACCP recommends the use of abciximab (Grade 1B). Recommended dosing for abciximab is 0.25 mg/kg IV bolus followed by 0.125 mcg/kg/min (maximum, 10 mcg/ min) for 12 h. . E. Antithrombin Therapy ÎFor patients with acute STEMI, in addition to aspirin and other antiplatelet therapies, the ACCP recommends the use of antithrombin therapy over no antithrombin therapy (Grade 1A), including for those patients receiving fibrinolysis (and regardless of which lytic agent is administered), primary PCI, or patients not receiving reperfusion therapy.

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