Drug | Dose | Initiation relative to PCI | Duration of therapy |
GP IIb/IIIa inhibitors* | |||
Eptifibatide | 180 mcg/kg IV bolus x2, given 10 minutes apart (maximum 22.6 mg each bolus). Start maintenance infusion of 2 mcg/kg/minute (maximum 15 mg/hour) immediately after first bolus. | Immediately prior to PCI | Up to 18 to 24 hours after PCI |
Adjustment for kidney impairment:
| |||
Tirofiban | 25 mcg/kg IV bolus administered over ≤5 minutes beginning after diagnostic coronary angiography, just before PCI; maintenance infusion: 0.15 mcg/kg/minute continued for up to 18 hours. | Up to 18 hours after PCI | |
Adjustment for kidney impairment (CrCl¶ ≤60 mL/minute): IV Loading dose: 25 mcg/kg administered over ≤5 minutes; maintenance infusion: 0.075 mcg/kg/minute. | |||
Anticoagulants | |||
Unfractionated heparin (no prior anticoagulant therapy)Δ | Without GP IIb/IIIa inhibitor: 70 to 100 units/kg IV bolus (maximum 10,000 units), with additional boluses if needed to achieve ACT target of 250 to 300 seconds◊. With GP IIb/IIIa inhibitor: 50 to 70 units/kg IV bolus (maximum 7000 units), with additional boluses if needed to achieve ACT target of 200 to 250 seconds. | Immediately prior to PCI | Discontinued at the end of the procedure |
Adjustment for kidney impairment: None. | |||
Enoxaparin | Not generally started for elective PCI. For the occasional patient already on 2 or more doses of therapeutic enoxaparin, it can be continued at prior dose with an additional 0.3 mg/kg IV if 8 to 12 hours since last SubQ dose. Refer to drug monograph for additional detail. If PCI >12 hours after last SubQ dose of therapeutic enoxaparin, an established anticoagulation regimen (eg, unfractionated heparin or bivalirudin) should be used | May continue for prior indication | |
Adjustment for kidney impairment (CrCl¶ <30 mL/minute or dialysis dependent): Avoid use. | |||
Bivalirudin | 0.75 mg/kg IV bolus, then maintenance infusion of 1.75 mg/kg/hour. | Immediately prior to PCI | Discontinued at the end of the procedure or continued for up to 4 hours after PCI |
Adjustment for kidney impairment:
|
PCI: percutaneous coronary intervention; GP: glycoprotein; IV: intravenous; CrCl: creatinine clearance; ACT: activated clotting time.
* Refer to clinical topic for approach to agent selection and timing of antithrombotic therapy with aspirin, platelet P2Y12 receptor blockers, parenteral anticoagulants, and GP IIb/IIIa inhibitors. UpToDate limits use of a GP IIb/IIIa inhibitor to selected higher thrombotic risk patients; refer to clinical topic.
¶ CrCl is estimated using Cockcroft-Gault equation. A calculator for determination of CrCl by Cockcroft Gault equation is available in UpToDate.
Δ If the patient received previous anticoagulation with heparin, IV bolus(es) (eg, 2000 to 5000 units) are given as needed to achieve target ACT.
◊ Goal ACT may vary depending on point-of-care ACT device.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟