Adjunc- tive antiplatelet and/or anticoagulant therapies are indicated, regardless of the choice of fibrinolytic agent. Table 4. Indications for Fibrinolytic Therapy When There Is a >120-Minute Delay From FMC to Primary PCI (Figure 2) COR LOE References Ischemic symptoms <12 h I A 81, 306 311 Evidence of ongoing ischemia 12 to 24 h after symptom onset, and a large area of myocardium at risk or hemodynamic instability IIa C N/A ST depression except if true posterior (inferobasal) MI suspected or when associated with ST-elevation in lead aVR COR indicates Class of Recommendation; FMC, first medical contact; LOE, Level of Evidence; MI, myocardial infarction; N/A, not available; and PCI, percutaneous coronary intervention. Table 5. Fibrinolytic Agents Fibrinolytic Agent Dose Fibrin Specificity* Antigenic Patency Rate Fibrin-specific: Tenecteplase (TNK-tPA) Single IV weight-based bolus ++++ No 85%328 Reteplase (rPA) 10 U + 10-U IV boluses given 30 min apart ++ No 84%314 Non fibrin-specific: Streptokinase 1.5 million units IV given over 30 60 min No Yes 60% to 68%324, 329 *Strength of fibrin specificity; ++++ is more strong, ++ is less strong. 30 mg for weight <60 kg; 35 mg for 60 69 kg; 40 mg for 70 79 kg; 45 mg for 80 89 kg; and 50 mg for 90 kg. Bolus 15 mg, infusion 0.75 mg/kg for 30 min (maximum 50 mg), then 0.5 mg/kg (maximum 35 mg) over the next 60 min; total dose not to exceed 100 mg. Streptokinase is no longer marketed in the United States but is available in other countries. Streptokinase is highly antigenic and absolutely contraindicated within 6 mo of previous exposure because of the potential for serious allergic reaction. IV indicates intravenous; rPA, reteplase plasminogen activator; TIMI, Thrombolysis In Myocardial Infarction; TNK-tPA, tenecteplase tissue-type plasminogen activator; and tPA, tissue-type plasminogen activator. 5.1.3. 