Treatment options include: Enoxaparin: 1 mg/kg subcutaneous (SC) every 12 hours (reduce dose to 1 mg/kg SC once daily in patients with creatinine clearance [CrCl] <30 mL/min), continued for the duration of hos- pitalization or until PCI is performed. An initial intravenous loading dose of 30 mg has been used in selected patients.133,136,309 (Level of Evidence: A) Bivalirudin: 0.10 mg/kg loading dose followed by 0.25 mg/kg per hour (only in patients managed with an early invasive strategy), continued until diagnostic angiography or PCI, with only provi- sional use of GP IIb/IIIa inhibitor, provided the patient is also treated with DAPT.292,293,310,311 (Level of Evidence: B) Fondaparinux: 2.5 mg SC daily, continued for the duration of hospitalization or until PCI is per- (Level of Evidence: B) If PCI is performed while the patient is on fondaparinux, an additional anticoagulant with anti-IIa activity (either UFH or bivalirudin) should be administered because of the risk of catheter (Level of Evidence: B) UFH IV: initial loading dose of 60 IU/kg (maxi- mum 4000 IU) with initial infusion of 12 IU/kg per hour (maximum 1000 IU/h) adjusted per activated partial thromboplastin time to maintain therapeu- tic anticoagulation according to the specific hospi- tal protocol, continued for 48 hours or until PCI is (Level of Evidence: B) 4.3.2.1. Low-Molecular-Weight Heparin LMWHs have a molecular weight approximately one third that of UFH and have balanced anti-Xa and anti-IIa activity. LMWHs are readily absorbed after subcutaneous administration and have less platelet activation.323 The anticoagulant activity of LMWH does not require routine monitoring. The dose of enoxaparin is 1 mg/kg SC every 12 hours for NSTE-ACS; an initial intravenous loading dose of 30 mg has been used in selected patients. 