Adjunctive Antithrombotic Therapy to Support PCI After Fibrinolytic Therapy COR LOE References Antiplatelet therapy Aspirin 162- to 325-mg loading dose given with fibrinolytic agent (before PCI). (Section 5.1.4.1 and Table 7) 81 mg daily is the preferred daily maintenance dose IIa B 253, 259, 263, 264 receptor inhibitors Loading doses For patients who received a loading dose of clopidogrel with fibrinolytic therapy: Continue clopidogrel 75 mg daily without an additional loading dose I C 260, 262, 330, 331 For patients who have not received a loading dose of clopidogrel: If PCI is performed 24 h after fibrinolytic therapy: clopidogrel 300-mg loading dose before or at the time of PCI I C N/A If PCI is performed >24 h after fibrinolytic therapy: clopidogrel 600-mg loading dose before or at the time of PCI I C N/A If PCI is performed >24 h after treatment with a fibrin-specific agent or >48 h after a non fibrin-specific agent: prasugrel 60 mg at the time of PCI For patients with prior stroke/TIA: prasugrel III: Harm B 260 Maintenance doses and duration of therapy DES placed: Continue therapy for at least 1 y with: Prasugrel: 10 mg daily IIa B 260, 262 BMS* placed: Continue therapy for at least 30 d and up to 1 y with: Clopidogrel: 75 mg daily I C 330, 331 Prasugrel: 10 mg daily IIa B 260, 262 Anticoagulant therapy Continue UFH through PCI, administering additional IV boluses as needed to maintain therapeutic ACT depending on use of GP IIb/IIIa receptor antagonist I C N/A Continue enoxaparin through PCI: I B 332, 390 No additional drug if last dose was within previous 8 h 0.3-mg/kg IV bolus if last dose was 8 to 12 h earlier Fondaparinux: III: Harm C 304 As sole anticoagulant for PCI *Balloon angioplasty without stent placement may be used in selected patients. 