Loading dose (following ACS event): 180 mg orally, single dose
The maintenance dose (for 1st 12 months after diagnosis): 90 mg orally two times
The maintenance dose (after 12 months from diagnosis): 60 mg orally two times
Also, continue with aspirin 75-100 mg

25

mcg/kg

Solution

Intravenous (IV)

5

minutes

180

mcg/kg

Solution

Intravenous (IV)

1 - 2

minutes

Later, 2 mcg/kg/min intravenously for 72 hours

Initial dose
:

60

mg

Tablet

Orally 

once a day

Maintenance dose: 10mg/day orally combined with 81-325mg/day aspirin

Non-ST-Elevation Myocardial Infarction (NSTEMI)
Loading dose:

300

mg

Tablet

Orally 

every day

Maintenance dose: 75 mg orally daily

ST-Elevation Myocardial Infarction (STEMI)
Loading dose: 300 mg orally daily
Maintenance dose: 75 mg orally daily with/without thrombolytics

PCI
Without the GPIIb or IIIa inhibitor: 70 to 100 unit/kg Intravenous bolus initially
With GPIIb or IIIa inhibitor: 50 to 70 units/kg Intravenous bolus initially
STEMI
Patient who are on fibrinolytics: IV bolus of 60 units/kg (maximum: 4000 units), following 12 units/kg in hour as continuous IV infusion (max 1000 units/hr)
The dose must be adjusted to keep the aPTT between 50 to 70 seconds
NSTEMI/Unstable Angina
6 to 70 units/kg intravenous bolus initially (maximum: 5000 units), following 12-15 units/kg in hour intravenous infusion initially (maximum: 1000 units/hr)
The dose must be adjusted to keep the aPTT between 50 to 70 secs
Dosing considerations
There are several concentrations available; extreme caution is necessary to prevent a medication error

Administer initial dose of 86 anti-Xa units/kg intravenously once bolus and the maximum dose not more than 9500 anti-Xa units
Fixed dosing:
<50 kg: dose of 3800 anti-Xa units once intravenous bolus
≥100 kg: dose of 9500 anti-Xa units once intravenous bolus
Administer maintenance dose of 86 anti-Xa units/kg subcutaneously each 12 hours and the maximum total daily dose not more than 19000 anti-Xa units
Fixed dosing:
<50 kg: dose of 3800 anti-Xa units subcutaneously each 12 hours
≥100 kg: dose of 9500 anti-Xa units subcutaneously each 12 hours

Acute Coronary Syndrome
<75 years:
Loading dose: 60mg orally
Maintenance dose: 10mg/day orally combined with 81-325mg/day aspirin
>75 years:
Not recommended due to intracranial bleeding