5.1.4.2. Adjunctive Anticoagulant Therapy With Fibrinolysis: Recommendations Class I 1. Patients with STEMI undergoing reperfusion with fi- brinolytic therapy should receive anticoagulant ther- apy for a minimum of 48 hours, and preferably for the duration of the index hospitalization, up to 8 days or until revascularization if performed.318,332 (Level of Evidence: A) Recommended regimens include a. UFH administered as a weight-adjusted intravenous bolus and infusion to obtain an activated partial thromboplastin time of 1.5 to 2.0 times control, for 48 hoursoruntilrevascularization.(LevelofEvidence:C); b. Enoxaparin administered according to age, weight, and creatinine clearance, given as an intravenous bolus, followed in 15 minutes by subcutaneous in- jection for the duration of the index hospitaliza- tion, up to 8 days or until revascularization.332 335 (Level of Evidence: A); or c. Fondaparinux administered with initial intrave- nous dose, followed in 24 hours by daily subcuta- neous injections if the estimated creatinine clear- ance is greater than 30 mL/min, for the duration of the index hospitalization, up to 8 days or until (Level of Evidence: B) Anticoagulation is recommended in support of fibrin-specific therapy to improve vessel patency and prevent reocclusion.336 Dosing of UFH is predicated on the activated partial throm- boplastin time, and monitoring of platelet counts to avoid the risks of excess bleeding and heparin-induced thrombocytopenia (HIT) is advised.318,337 339 UFH may be given as an intravenous bolus and infusion for patients receiving streptokinase if they are at high risk for systemic embolization. Enoxaparin is pre- ferred over UFH for anticoagulation extending beyond 48 hours. Caution is advised when enoxaparin is administered to patients Table 6. 