In this subset, the use of prasugrel compared to clopidogrel was associated with a significantly lower rate of the primary composite endpoint of cardiovascular death, nonfatal MI, or nonfatal stroke (HR: TIMI major bleeding unrelated to CABG.262 Accordingly, pra- sugrel (60-mg loading dose) may be used as an alternative to clopidogrel in patients with STEMI who undergo delayed PCI after administration of a fibrinolytic agent. 6.4.2. Anticoagulant Therapy to Support PCI After Fibrinolytic Therapy: Recommendations Class I 1. For patients with STEMI undergoing PCI after re- ceiving fibrinolytic therapy with intravenous UFH, additional boluses of intravenous UFH should be ad- ministered as needed to support the procedure, tak- ing into account whether GP IIb/IIIa receptor antag- onists have been administered. (Level of Evidence: C) 2. For patients with STEMI undergoing PCI after re- ceiving fibrinolytic therapy with enoxaparin, if the last subcutaneous dose was administered within the prior 8 hours, no additional enoxaparin should be given; if the last subcutaneous dose was administered between 8 and 12 hours earlier, enoxaparin 0.3 mg/ kg IV should be given.335,390 (Level of Evidence: B) Class III: Harm 1. Fondaparinux should not be used as the sole anticoag- ulant to support PCI.An additional anticoagulant with anti-IIa activity should be administered because of the risk of catheter thrombosis.304 (Level of Evidence: C) Anticoagulation should be continued through emergent or nonurgent PCI procedures performed during the index hospi- talization after initial use of fibrinolytic therapy. For patients who received UFH or enoxaparin with fibrinolytic therapy, these agents may be continued uninterrupted through the PCI Transitioning from enoxaparin to either UFH or bivalirudin is possible, provided the last enoxaparin dose was >12 hours before PCI. Similarly, UFH may be transitioned to bivalirudin for PCI. 