TABLE 1.
Summary of the concomitant medications administered with thrombolytics for ST‐elevation myocardial infarction (STEMI)
| Medication | Dosing | |
|---|---|---|
| Thrombolytics 2 , 3 | ||
| Give within 30 min of hospital arrival | ||
| Tenecteplase | Single intravenous bolus given over 5 s a : | |
| <60 kg: 30 mg | ||
| ≥60 to <70 kg: 35 mg | ||
| ≥70 to <80 kg: 40 mg | ||
| ≥80 to <90 kg: 45 mg | ||
| ≥90 kg: 50 mg | ||
| Reteplase | Double intravenous bolus given over 2 min: | |
| 10 units followed by a second dose 30 min later of 10 units | ||
| Alteplase | Accelerated regimen (weight‐based): | |
| >67 kg: total dose: 100 mg over 1.5 h; 15 mg IV bolus over 1‐2 min followed by infusions of 50 mg over 30 min, then 35 mg over 1 h | ||
| ≤67 kg: Infuse 15 mg IV bolus over 1‐2 min followed by infusions of 0.75 mg/kg (not to exceed 50 mg) over 30 min then 0.5 mg/kg (not to exceed 35 mg) over 1 h. Maximum total dose: 100 mg | ||
| Aspirin 2 , 3 | Loading | 324 mg |
| Maintenance | 81 mg by mouth daily | |
| Clopidogrel 7 , 8 , 9 , 10 | Loading | At the time of thrombolytics |
| Age ≤75 y: 300 mg | ||
| Age >75 y: 75 mg | ||
| At the time of PCI | ||
| Thrombolytic ≤24 h ago: total of 300 mg (regardless of age) | ||
| Thrombolytic >24 h ago: total of 600 mg (regardless of age) | ||
| Maintenance | 75 mg by mouth daily | |
| Unfractionated Heparin 2‐3,10 | Loading | 60 units/kg (maximum of 4000 units) |
| Maintenance | Initiate at 12 units/kg/h (maximum of 1000 units/hour and titrate to institutional protocol) | |
| Enoxaparin 2 , 3 , 10 | Loading | Age <75 y: Single IV bolus of 30 mg |
| Age ≥75 y: No IV bolus is administered | ||
| Maintenance | Age <75 y: 1 mg/kg (maximum: 100 mg for the first 2 doses only) subcutaneously every 12 h or if CrCl less than 30 mL/min 1 mg/kg subcutaneously every 24 h. First dose to be given with the IV bolus | |
| Age ≥75 y: 0.75 mg/kg (maximum: 75 mg for the first 2 doses only) subcutaneously every 12 h or if CrCl less than 30 mL/min 0.75 mg/kg subcutaneously every 24 h |
Abbreviations: CrCl, creatinine clearance; IV, intravenous; PCI, percutaneous coronary intervention.
a
Consider reducing weight‐based dose by 50% for patients greater than or equal to 75 years of age. 29