Recommendations for Antiplatelet and Antithrombin Pharmacotherapy at the Time of PCI COR LOE References Relevant Caveats/Comments Oral antiplatelet agents Aspirin I B 301 304,560 563 N/A P2Y12 inhibitors I A 564 568 A loading dose of a P2Y12 inhibitor should be given to patients undergoing PCI with stenting. Clopidogrel I B 564 566 600-mg loading dose now recommended. Prasugrel I B 567 Contraindicated in patients with prior TIA/CVA: Class III: Harm; LOE: B. Generally not recommended in patients 75 y of age (Section 5.7.2). Consideration of using a lower maintenance dose in patients weighing 60 kg suggested by FDA (Section 5.7.2). Ticagrelor I B 568 Issues of patient compliance may be especially important. GP IIb/IIIa inhibitors (abciximab, double-bolus eptifibatide, high-bolus dose tirofiban) No clopidogrel pretreatment STEMI: IIa A 584 590 UA/NSTEMI recommendation applies to those with high-risk features. GPI use in STEMI may be most appropriate in those with large anterior MI and/or large thrombus burden. IC abciximab administration in STEMI: Class IIb; LOE: B. Precatheterization laboratory GPI administration in STEMI: Class III: No Benefit; LOE: B. Recommendations apply to those not at high risk for bleeding complications. UA/NSTEMI: I A 613 618 SIHD: IIa B 619 621 Clopidogrel pretreatment STEMI: IIa C 584 590 UA/NSTEMI: IIa B 616,619 SIHD: IIb B 619,622 624 Antithrombin agents UFH I C N/A Dosing based on whether or not GPI was administered. Bivalirudin I B 625,637 645 Lower bleeding rates associated with bivalirudin are mitigated when used concomitantly with a GPI. Enoxaparin IIb B 646 650 Recommendations apply to administration of IV enoxaparin at the time of PCI for those who have not received prior antithrombin therapy or who have received upstream SC enoxaparin therapy for UA/NSTEMI. 