Anticoagulant Medications
| Medication | Dosage | Comments |
|---|
| Heparin (UFH) | 60 units/kg IV bolus (maximum dose: 4000 units), 12–14 units/kg/h | - Heparin therapy, when used in conjunction with ASA, has been shown to reduce the early rate of death or MI by up to 60%.64
- The aPTT should be adjusted to maintain a value of 1.5–2.0 times control.
| | Enoxaparin (LMWH) | 1 mg/kg Sub-Q bida | - LMWH is at least as efficacious as UFH and may further reduce the rate of death, MI, or recurrent angina.65
- LMWH may increase the rate of bleeding62 and cannot be reversed in the setting of refractory bleeding.
- LMWH does not require monitoring for clinical effect.
| | Fondaparinux | 2.5 mg Sub-Q daily | - Fondaparinux has efficacy similar to that of LMWH with possibly reduced bleeding rates.66
| | Bivalirudinb | 0.75 mg/kg IV bolus, 1.75 mg/kg/h | - When used in conjunction with ASA and clopidogrel, bivalirudin is at least as effective as the combination of ASA, UFH, clopidogrel, and GPIIb/IIIa antagonists with decreased bleeding rates.67 May increase risk for stent thrombosis.
- Monitoring is required with a goal aPTT of 1.5–2.5 times control.
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aPTT, activated partial thromboplastin time; ASA, aspirin; GFR, glomerular filtration rate; GP, glycoprotein; LMWH, low–molecular-weight heparin; MI, myocardial infarction; UFH, unfractionated heparin.
a LMWH should be given at reduced dose (50%) in patients with a serum creatinine >2 mg/dL or GFR < 30 mL/min.
b Bivalirudin requires dosage adjustment in patients with a GFR less than 30 mL/min or those on hemodialysis.