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NSTEMI INITIAL DOSING GUIDE(Referenced Version)

This dosing guide lists initial drugs and doses that should be highly considered based upon recent clinical practiceguidelines, medication package inserts, and emerging evidence.

WEIGHT AND CREATININE CLEARANCE

Determine patients weight (kg)

Determine CrCl ml/min = (140 age) X weight (kg)/(serum creatinine X 72) multiply by 0.85 if female

ORAL ANTIPLATELET AGENTS

tAspirin: 162 mg to 325 mg non-enteric chewed initially then 81 mg to 162 mg daily (or 162 mg to 325 mgdaily after stent implantation).1

tClopidogrel:Loading dose 300 mg to 600 mg orally, then daily dose of 75 mg orally2(Withhold for 5 days if CABG is planned; for BMS and DES ideally continue for at one year)3

ANTICOAGULANT THERAPY

tUnfractionated Heparin:Bolus: 60 U/kg IV (not to exceed 4000 U)Infusion: 12 U/kg/hr IV (not to exceed 1000U/hr) to goal aPTT 1.5 to 2.0 times local reference standard;check PTT in 6 hours and adjust heparin as below. 4

(Continue for 48 hours or until PCI)

If PTT < 1x control: re-bolus 60 U/kg (max 4000 U) and increase infusion by 2 U/kg/hrPTT 1 to 1.5x control: increase infusion by 2 U/kg/hrPTT 1.5 to 2x control (approx 50-70 sec): no change (therapeutic range)PTT 2 to 3x control: decrease infusion rate by 2 U/kg/hr

PTT > 3x control: stop infusion, recheck PTT in 1 hour, follow algorithm based on repeat PTT

tEnoxaparin: 1 mg/kg subcutaneous every 12 hours (if CrCl < 30mL/min, give 1 mg/kg every 24 hours)(Continue for the shorter of the duration of hospitalization, 8 days, or until PCI) 5

tBivalirudin: Bolus: 0.1 mg/kg IVInfusion: 0.25 mg/kg/hr IV (caution if CrCl < 30 mL/min)6

(Continue for the shorter of the duration of hospitalization, 8 days, or until PCI)

tFondaparinux: 2.5 mg subcutaneously once daily (avoid if CrCl < 30mL/min)7(Continue for the shorter of the duration of hospitalization, 8 days, or until PCI)

GLYCOPROTEIN IIb/IIIa

tEptifibatide: Loading: 180 mcg/kg IV bolusInfusion: 2.0 mcg/kg/min (reduce to 1.0 mcg/kg/min if CrCl < 50mL/min)8

tTirofiban: Loading: 0.4 mcg/kg/min for 30 minutes (reduce to 0.2 mcg/kg/min for CrCl 30mL/min)Infusion: 0.1 mcg/kg/min, reduce to 0.05 mcg/kg/min if CrCl 30mL/min)9

tAbciximab: Loading: 0.25 mcg/kg IV bolus (reserve for patients with planned PCI within 12 hours)Infusion: 0.125 mcg/kg/min IV10

(Continue for the shorter of the duration of hospitalization, 8 days, or until PCI)

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EndNotes

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1Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable

angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart AssociationTask Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients WithUnstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of

Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeonsendorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for AcademicEmergency Medicine.J Am Coll Cardiol. 2007;50:e1-e1572Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.48.

3Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.48.

4Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.5Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.

6Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.7

Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.8Anderson JL, Adams CD, Antman EM, et al, 2007, e 38.

9Anderson JL, Adams CD, Antman EM, et al, 2007, e38. 10Anderson JL, Adams CD, Antman EM, et al, 2007, e38.

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