An additional bolus of 0.3 mg/kg can be given if needed. I B 248 Reduce infusion to 1 mg/kg/h with estimated CrCl <30 mL/min Preferred over UFH with GP IIb/IIIa receptor antagonist in patients at high risk of bleeding IIa B 248 Fondaparinux: Not recommended as sole anticoagulant for primary PCI III: Harm B 304 *The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily. Balloon angioplasty without stent placement may be used in selected patients. It might be reasonable to provide P2Y12 inhibitor therapy to patients with STEMI undergoing balloon angioplasty alone according to the recommendations listed for BMS. (LOE: C) The recommended ACT with planned GP IIb/IIIa receptor antagonist treatment is 200 to 250 s. The recommended ACT with no planned GP IIb/IIIa receptor antagonist treatment is 250 to 300 s (HemoTec device) or 300 to 350 s (Hemochron device). ACT indicates activated clotting time; BMS, bare-metal stent; CrCl, creatinine clearance; COR, Class of Recommendation; DES, drug-eluting stent; GP, glycoprotein; IV, intravenous; LOE, Level of Evidence; N/A, not available; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction; TIA, transient ischemic attack; and UFH, unfractionated heparin. O Gara et al 2013 ACCF/AHA STEMI Guideline e377 2. After PCI, aspirin should be continued indefinite- (Level of Evidence: A) 3. A loading dose of a P2Y12 receptor inhibitor should be given as early as possible or at time of primary PCI to patients with STEMI. Options include a. 