The risk of major bleeding complications is increased when CABG is performed <24 hours after dis- continuation of clopidogrel.23,416,417 In patients who undergo CABG 1 to 4 days after discontinuation of clopidogrel, it appears that the incidence of life-threatening bleeding is not significantly increased, but an increase in blood transfusions is In the TRITON-TIMI 38 trial,302 the inci- dence of CABG-related major bleeding was higher in patients treated with prasugrel than in patients treated with clopido- In the PLATO trial, the rates of major bleeding and transfusion requirements were similar between patients treated with ticagrelor and patients treated with clopidogrel.294 The more rapid recovery of platelet function in pharmacokinetic Table 9. Dosing of Parenteral Anticoagulants During PCI Drug* In Patients Who Have Received Prior Anticoagulant Therapy In Patients Who Have Not Received Prior Anticoagulant Therapy Enoxaparin For prior treatment with enoxaparin, if last SC dose was administered 8 12 h earlier or if <2 therapeutic SC doses of enoxaparin have been administered, an IV dose of enoxaparin 0.3 mg/kg should be given 0.5 mg/kg-0.75 mg/kg IV loading dose If the last SC dose was administered within 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 loading dose, then 1.75 mg/kg/h IV infusion 0.75 mg/kg loading dose, 1.75 mg/kg/h IV infusion For patients already receiving bivalirudin infusion, give additional loading dose 0.5 mg/kg and increase infusion to 1.75 mg/kg/h during PCI Fondaparinux For prior treatment with fondaparinux, administer additional IV treatment with anticoagulant possessing anti-IIa activity, considering whether GPI receptor antagonists have been administered N/A UFH IV GPI planned: additional UFH as needed (eg, 2000 5000 U) to achieve ACT of 200 250 s IV GPI planned: 50 70 U/kg loading dose to achieve ACT of No IV GPI planned: additional UFH as needed (eg, 2000 5000 U) to achieve ACT of 250 300 s for HemoTec, 300 350 s for Hemochron No IV GPI planned: 70 100 U/kg loading dose to achieve target ACT of 250 300 s for HemoTec, 300 350 s for Hemochron *Drugs presented in order of the COR and then the LOE as noted in the Preamble. 