ANTICOAGULATION PROTOCOL

IN PRIMARY PCI
PATIENTS ON OAC
 PATIENTS ON OAC
• Aspirin immediately [300mg oral loading dose or
75–150mg i.v. (intravenous)]
• Clopidogrel is the P2Y12 inhibitor of choice
(600mg loading dose given at the time of primary
PCI).
• More potent P2Y12 inhibitors are generally not
routinely recommended.
• Radial approach is strongly recommended.

• ESC guidelines 2015, 2017

• MATRIX trial 2015
• Low-dose regardless of the timing of the last
dose of OAC(VKA or NOAC) (e.g.enoxaparin
0.5mg/kg i.v. or UFH 60IU/kg).
• In elective procedure uninterrupted OAC
alternative to bridging therapy.
• On VKAs INR > 2.5- no need/ Low dose
• On NOACs, Low dose
• GPIs should be avoided unless for bail-out
situations.
High Atherothrombotic risk

• For Elective PCI, use SYNTAX score

• For ACS, GRACE score >140

• Stenting of the left main

• Proximal LAD
• Proximal bifurcation
• Recurrent MI
• Stent thrombosis