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STEMI INITIAL DOSING GUIDE

(Referenced Version)

This dosing guide lists initial drugs and doses that should be highly considered based upon recent guidelines, emerging guidelines and medication package inserts.

WEIGHT AND CREATININE CLEARANCE

Top of Form

1. Determine patient’s weight (kg).

2. CrCl ml/min = (140 – age) X weight (kg)/(serum creatinine X 72) multiply by 0.85 if female.

ASPIRIN and CLOPIDOGREL (ALL)

( Aspirin: Initial: 162 mg to 325 mg non-enteric chewed.[i]

Daily: 81 mg to 162 mg (or 162 to 325 mg after stent implantation).[ii] [iii]

□ Clopidogrel: Fibrinolytic or No Reperfusion Patients[iv]:

Initial: 300 mg orally (No evidence for loading dose in age ≥75 years)

Daily: 75 mg orally

PCI Patients[v] :

Initial: 300-600 mg orally (No evidence for loading dose in age ≥75 years)

Daily: 75 mg orally

FIBRINOLYTIC THERAPY

( Streptokinase: 1.5 MU IV over 30-60 minutes[vi]

( Alteplase: Bolus: 15 mg IV

Infusion: 0.75 mg/kg IV over 30 minutes (not to exceed 50 mg); then 0.5 mg/kg over the next 60 minutes (not to exceed 35 mg over the next 60 minutes)[vii]

( Reteplase: 10 U IV over 2 minutes, repeat after 30 minutes[viii]

( Tenecteplase: if < 60 kg, give 30 mg single IV bolus;

if 60-69 kg, give 35 mg single IV bolus;

if 70-79 kg, give 40 mg single IV bolus;

if 80-89 kg, give 45 mg single IV bolus;

if > 90kg, give 50 mg single IV bolus.[ix]

ANTICOAGULANT THERAPY (FIBRINOLYTIC OR NO REPERFUSION PATIENTS)

( Unfractionated Heparin:

Bolus: 60 U/kg IV (not to exceed 4000 U regardless of weight)

Infusion: 12 U/kg/hr IV (not to exceed 1000U/hr regardless of weight) to goal PTT 1.5 to 2.0 times local reference standard; check PTT in 6 hours and adjust heparin as indicated)[x]

If PTT < 1x control: re-bolus 60 units/kg (max 4000 unit) and increase infusion by 2 units/kg/hr

PTT 1 to 1.5x control: increase infusion by 2 units/kg/hr

PTT 1.5 to 2x control (approx 50-70 sec): no change (therapeutic range)

PTT 2 to 3x control: decrease infusion rate by 2 units/kg/hr

PTT > 3x control: stop infusion, recheck PTT in 1 hour, follow algorithm based on repeat PTT

( Enoxaparin*: Bolus: 30 mg IV (no IV bolus if age >75 years)

Maintenance: 1mg/kg subcutaneously every 12 hours, first dose 15 minutes after bolus (if age > 75 years, give 0.75 mg/kg every 12 hours with no bolus; if CrCl 75 years)

Maintenance: 1mg/kg subcutaneously every 12 hours, first dose 15 minutes after bolus (if age >75 years, give 0.75 mg/kg every 12 hours with no bolus; if CrCl ................
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