Aspirin 162 to 325 mg should be given before pri- (Level of Evidence: B) Balloon angioplasty without stent placement may be used in selected patients. Table 3. Adjunctive Antithrombotic Therapy to Support Reperfusion With Primary PCI COR LOE References Antiplatelet therapy Aspirin 162- to 325-mg load before procedure I B 251 253 81 mg daily is the preferred maintenance dose* IIa B 253, 254, 263, 264 inhibitors Loading doses Clopidogrel: 600 mg as early as possible or at time of PCI I B 253, 258, 259 Prasugrel: 60 mg as early as possible or at time of PCI I B 260 Ticagrelor: 180 mg as early as possible or at time of PCI I B 261 Maintenance doses and duration of therapy DES placed: Continue therapy for 1 y with: Clopidogrel: 75 mg daily I B 260, 262 Prasugrel: 10 mg daily I B 262 Ticagrelor: 90 mg twice a day* I B 261 BMS placed: Continue therapy for 1 y with: Clopidogrel: 75 mg daily I B 260, 262 Prasugrel: 10 mg daily I B 262 Ticagrelor: 90 mg twice a day* I B 261 DES placed: Clopidogrel, prasugrel, or ticagrelor* continued beyond 1 y IIb C N/A Patients with STEMI with prior stroke or TIA: prasugrel III: Harm B 260 IV GP IIb/IIIa receptor antagonists in conjunction with UFH or bivalirudin in selected patients Abciximab: 0.25-mg/kg IV bolus, then 0.125 mcg/kg/min (maximum 10 mcg/min) IIa A 265 267 Tirofiban: (high-bolus dose): 25-mcg/kg IV bolus, then 0.15 mcg/kg/min IIa B 268, 269 In patients with CrCl <30 mL/min, reduce infusion by 50% Eptifibatide: (double bolus): 180-mcg/kg IV bolus, then 2 mcg/kg/min; a second 180-mcg/kg bolus is administered 10 min after the first bolus IIa B 270 In patients with CrCl <50 mL/min, reduce infusion by 50% Avoid in patients on hemodialysis Pre catheterization laboratory administration of IV GP IIb/IIIa receptor antagonist IIb B 103, 268, 271 277 Intracoronary abciximab 0.25-mg/kg bolus IIb B 223, 278 284 Anticoagulant therapy UFH: I C N/A With GP IIb/IIIa receptor antagonist planned: 50- to 70-U/kg IV bolus to achieve therapeutic ACT With no GP IIb/IIIa receptor antagonist planned: 70- to 100-U/kg bolus to achieve therapeutic ACT I C N/A Bivalirudin: 0.75-mg/kg IV bolus, then 1.75-mg/kg/h infusion with or without prior treatment with UFH. 