What is the loading dose of mi
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What is the loading dose for mi
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Here is a summary of loading doses for key drugs used in Myocardial Infarction (MI), pulled from authoritative textbooks (Washington Manual of Medical Therapeutics, Harrison's Principles, Katzung's Pharmacology, and Braunwald's Heart Disease):
Loading Doses in Myocardial Infarction
Antiplatelet Agents
| Drug | Loading Dose | Maintenance | Notes |
|---|---|---|---|
| Aspirin (ASA) | 162-325 mg (chewed/crushed) | 75-100 mg/day | Non-enteric-coated, given orally or rectally; chewing improves absorption |
| Clopidogrel | 600 mg orally | 75-150 mg/day | 300 mg loading for NSTEMI (older regimen); 600 mg preferred for STEMI/PCI. Avoid loading dose in elderly |
| Prasugrel | 60 mg orally | 10 mg/day | More potent and faster than clopidogrel. Avoid in patients >75 years, <60 kg, or with prior stroke/TIA |
| Ticagrelor | 180 mg orally | 90 mg twice daily | ASA dose must not exceed 100 mg/day when used with ticagrelor. Shows mortality benefit over clopidogrel |
| Cangrelor | 30 mcg/kg IV bolus | 4 mcg/kg/min infusion | IV P2Y12 inhibitor; FDA-approved for patients undergoing PCI only |
Anticoagulants
| Drug | Loading Dose | Maintenance | Notes |
|---|---|---|---|
| Unfractionated Heparin (UFH) | 60 units/kg IV bolus (max 4,000 units) | 12 units/kg/h | Given to all patients undergoing PCI and those receiving thrombolytics (except streptokinase) |
| Enoxaparin (LMWH) | 30 mg IV bolus | 1 mg/kg SC q12h | Dose adjustments needed in renal impairment and elderly |
Glycoprotein IIb/IIIa Inhibitors (high-risk ACS/STEMI with large thrombus)
- Tirofiban and Eptifibatide - used as IV infusions in selected STEMI/high-risk ACS cases, particularly when cangrelor is not available
Key Clinical Notes
- STEMI: Aspirin + a P2Y12 inhibitor (prasugrel or ticagrelor preferred over clopidogrel) + anticoagulation is the standard upstream therapy before PCI.
- NSTEMI: Clopidogrel 300 mg loading dose (or ticagrelor 180 mg) + aspirin is commonly used.
- Cangrelor may replace oral P2Y12 inhibitors in patients who have not received a pre-procedural oral agent.
(Sources: Washington Manual of Medical Therapeutics; Harrison's Principles of Internal Medicine 22nd Ed.; Katzung's Basic and Clinical Pharmacology 16th Ed.; Braunwald's Heart Disease)
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