Table 9

Dosing of Parenteral Anticoagulants During PCI

DrugIn 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 mg/kg–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

Modified from Levine et al. (26).

ACT indicates activated clotting time; COR, Class of Recommendation; GPI, glycoprotein IIb/IIIa inhibitor; IV, intravenous; LOE, Level of Evidence; N/A, not applicable; PCI, percutaneous coronary intervention; SC, subcutaneous; and UFH, unfractionated heparin.

  • Drugs presented in order of the COR and then the LOE as noted in the Preamble. When more than 1 drug exists within the same LOE, and there are no comparative data, then the drugs are listed alphabetically.