Table 3.11-6. Fibrinolysis in patients with STEMI

Fibrinolytic agent

Dosage

Anticoagulant therapya

tPA

IV bolus 15 mg, then 0.75 mg/kg over 30 min, then 0.5 mg/kg over 60 min (up to a total of ≤100 mg)

UFH: 60 IU/kg in IV bolus (up to 4000 IU), then 12 IU/kg/h in IV infusion (up to 1000 IU/h) for 24-48 hours. Target aPTT, 50-70 s; check aPTT after 3, 6, 12, and 24 h

Enoxaparin:

– Patients <75 years: 30 mg IV bolus, then after 15 min 1 mg/kg SC every 12 h. The 2 initial SC doses should be ≤100 mg

– Patients >75 years: No IV bolus; start with 0.75 mg/kg SC every 12 h. The 2 initial SC doses should be ≤75 mg

– Patients with creatinine clearance <30 mL/min, regardless of age: SC injections every 24 h

Fondaparinux: 2.5 mg IV, then 2.5 mg SC every 24 h

TNK tPA

Single IV injection at a dose based on body weight:

<60 kg: 30 mg

60-70 kg: 35 mg

70-80 kg: 40 mg

80-90 kg: 45 mg

>90 kg: 50 mg

SK

1.5 million IU in 100 mL of 5% glucose (dextrose) or 0.9% saline, IV infusion over 30-60 min

Fondaparinux: 2.5 mg SC, then 2.5 mg/d SC every 24 h

a Administer until discharge but no longer than for 8 days. In patients with severe renal failure (creatinine clearance <20 mL/min) use unfractionated heparin rather than other anticoagulants.

aPTT, activated partial thromboplastin time; IV, intravenous; SC, subcutaneous; SK, streptokinase; STEMI, ST-segment elevation myocardial infarction; TNK tPA, tenecteplase; tPA, alteplase; UFH, unfractionated heparin.