ACS indications/dose

NTG dose

SL tablet 0.3-0.4 mg q5min as needed for chest pain x ≤ 3 doses

ASA dose- acute care

162-325 mg as soon as possible (enteric coated)

Clopidogrel loading dose

600 mg or 300 mg x 1 dose

Clopidogrel maintenance dose

75 mg PO daily

Prasugrel loading dose

60 mg x 1 dose

Prasugrel maintenance dose

10 mg PO daily                

5 mg if < 60 kg or ≥ 75 yr

Ticagrelor loading dose

180 mg x 1 dose

Ticagrelor maintenance dose

90 mg PO BID x 12 mos.

then 60 mg BID

Clopidogrel indications

•ACS with PCI

•NSTE-ACS noninvasive

•STEMI with fibrinolytic

Prasugrel indications

•ACS with PCI

ticagrelor indications

•ACS with PCI

•NSTE-ACS nonvasive

▪ACS with PCI

oFirst line = __________ or _____________ (class 1 rec., LOE B-R)

- Recommended to ↓ MACE and stent thrombosis

o Alternative = Clopidogrel

Prasugrel or Ticagrelor

▪NSTE-ACS Noninvasive

o First line = ___________ (class 1 rec., LOE B-R)

-Recommended to ↓ MACE

oAlternative = Clopidogrel

Ticagrelor

▪STEMI with Fibrinolytic

_ given concurrently to ↓ MACE

 Clopidogrel

UFH dose

60 units/kg IV bolus followed by 12 units/kg/hr IV continuous infusion titrated based on hospital-specific aPTT or heparin anti-Xa levels

UFH indication

any ACS management strategy

Enoxaparin dose

1 mg/kg subcutaneously q12h

Enoxaparin indication

STEMI with fibrinolytics = recommended 

NSTE-ACS alternative for any strategy

Bivalirudin dose

▪IV bolus followed by continuous infusion

Bivalirudin indication

Patients undergoing PCI with history of HIT, replaces UFH

Fondaparinux dose

2.5 mg SC daily

Fondaparinux indications

▪NSTE-ACS noninvasive or selective invasive (no current plans for PCI)

▪STEMI with fibrinolytics