Dosage of anticoagulants in patients with non–ST-segment elevation acute coronary syndrome

Agent

Dosage

Oral antiplatelet agents

ASA

Loading dose (only in patients not receiving prior ASA) 150-300 mg (preferably chewing an uncoated tablet), then lifelong treatment 75-100 mg/d

Clopidogrel

Loading dose 600 mg, followed by 75 mg/d or 150 mg/d (after PCI for 7 days), followed by 75 mg/d

Prasugrel

Loading dose 60 mg followed by 10 mg once daily

Ticagrelor

Loading dose 180 mg followed by 90 mg bid

Anticoagulantsa

Fondaparinux

2.5 mg subcutaneously every 24 h

Enoxaparin

1 mg/kg subcutaneously every 12 hb

Dalteparin

120 IU/kg subcutaneously every 12 h

Nadroparin

86 IU/kg subcutaneously every 12 h

Unfractionated heparin

60-70 IU/kg (up to 5000 IU) in IV injection, followed by 1215 IU/kg/h (up to 1000 IU/h) as infusion; maintain aPTT 1.5-2.5 × ULN

Bivalirudin

In urgent invasive strategy 0.75 mg/kg IV injection followed by 1.75 mg/kg/h IV infusion; in other cases, 0.1 mg/kg IV injection and 0.25 mg/kg/h IV infusion until PCI; administer additional 0.5 mg/kg injection and increase infusion rate to 1.75 mg/kg/h prior to PCI

GP IIb/IIIa receptor antagonists (used in some high-risk patients at the discretion of the invasive cardiologist)c

Abciximab

0.25 mg/kg IV injection followed by 0.125 microg/kg/min (up to 10 microg/min) IV infusion for 12 h

Eptifibatide

180 microg/kg IV injection repeated after 10 min and followed by 2 microg/kg/min IV infusion for 18 h

Tirofiban

25 microg/kg IV injection over 3 min followed by 0.15 microg/kg/min infusion for 18 h

a In patients with renal failure, use unfractionated heparin.

b Patients with renal failure require dose adjustment.

c Consider dose reduction in elderly patients and patients with moderate renal insufficiency.

Based on the 2007 and 2011 European Society of Cardiology guidelines. See Additional Information for details.

aPTT, activated partial thromboplastin time; ASA, acetylsalicylic acid; bid, two times a day; IV, intravenous administration; PCI, percutaneous coronary intervention; ULN, upper limit of normal.