NSTEMI INITIAL DOSING GUIDE

(Referenced Version)
This dosing guide lists initial drugs and doses that should be highly considered based upon recent clinical practice
guidelines, medication package inserts, and emerging evidence.

WEIGHT AND CREATININE CLEARANCE

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

ORAL ANTIPLATELET AGENTS

❏ Aspirin: 162 mg to 325 mg non-enteric chewed initially then 81 mg to 162 mg daily (or 162 mg to 325 mg
daily after stent implantation).1
❏ Clopidogrel: 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
❏ Unfractionated 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/hr
PTT 1 to 1.5x control: increase infusion by 2 U/kg/hr
PTT 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

❏ Enoxaparin: 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
❏ Bivalirudin: Bolus: 0.1 mg/kg IV
Infusion: 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)

❏ Fondaparinux: 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
❏ Eptifibatide: Loading: 180 mcg/kg IV bolus
Infusion: 2.0 mcg/kg/min (reduce to 1.0 mcg/kg/min if CrCl < 50mL/min)8
❏ Tirofiban: 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

❏ Abciximab: 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)

Page 1 of 3
EndNotes

Page 2 of 3
1
Anderson 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 Association
Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With
Unstable 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 Surgeons
endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic
Emergency Medicine. J Am Coll Cardiol. 2007;50:e1-e157
2
Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.48.
3
Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.48.
4
Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.
5
Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.
6
Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.
7
Anderson JL, Adams CD, Antman EM, et al, 2007, e 37.
8
Anderson JL, Adams CD, Antman EM, et al, 2007, e 38.
9
Anderson JL, Adams CD, Antman EM, et al, 2007, e38.
10
Anderson JL, Adams CD, Antman EM, et al, 2007, e38.

Copyright © 2008 by the American College of Cardiology. This content is owned by the ACC. A person accessing it may
print the material and use it for his or her personal, institutional, non-commercial reference. Other terms and conditions
for use may apply, particularly for commercial purposes. For more details, please contact the ACC in writing. This material
is intended for reference and does not represent ACC policy. This content is not endorsed by the ACC. If any modifications
are made to the content or layout of this material, all representation of the material as derived from ACC or NCDR should
be removed.