0.5 to 0.75 mg/kg IV bolus If the last SC dose was administered within the prior 8 h, no additional enoxaparin should be given. Bivalirudin For patients who have received UFH, wait 30 min, then give 0.75 mg/kg IV bolus, then 1.75 mg/kg per h IV infusion. 0.75 mg/kg bolus, 1.75 mg/kg per h IV infusion Fondaparinux For prior treatment with fondaparinux, administer additional IV treatment with an anticoagulant possessing anti-IIa activity, taking into account whether GPI receptor antagonists have been administered. N/A Argatroban 200 mcg/kg IV bolus, then 15 mcg/kg per min IV infusion 350 mcg/kg bolus, then 25 mcg/kg per min IV infusion ACT indicates activated clotting time; IV, intravenous; GPI, glycoprotein inhibitor; N/A, not applicable; PCI, percutaneous coronary intervention; SC, subcutaneous; and UFH, unfractionated heparin. 2. For patients with heparin-induced thrombocytopenia, it is recommended that bivalirudin or argatroban be used to replace UFH.668,669 (Level of Evidence: B) Bivalirudin is being increasingly used in clinical practice670 as evidence emerges from clinical trials across the spectrum of CAD.638 644 In individual trials and meta-analyses, the use of bivalirudin has been associated with reduced bleeding compared with UFH plus a GP IIb/IIIa inhibitor, although concerns about ischemic events have emerged in individual studies.625,637 645 Longer-term follow-up of the major bivali- rudin trials, however, suggests that small or nominal in- creases in ischemic events have not translated into long-term consequences and that treatment at or before the time of PCI with clopidogrel may mitigate any increased early ischemic risk.637 645 Thus, a treatment strategy of bivalirudin compared with heparin (or enoxaparin) plus GP IIb/IIIa inhibitor ap- pears to lower the risk of bleeding complications. 