Table 3.11-3. 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 SC every 24 h

Enoxaparin

1 mg/kg SC every 12 hb

Dalteparin

120 IU/kg SC every 12 h

Nadroparin

86 IU/kg SC every 12 h

Unfractionated heparin

60-70 IU/kg (up to 5000 IU) in IV injection, followed by 12 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.

aPTT, activated partial thromboplastin time; ASA, acetylsalicylic acid; bid, 2 times a day; IV, intravenous; PCI, percutaneous coronary intervention; SC, subcutaneous; ULN, upper limit of normal.