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If streptokinase (SK) or anistreplase (APSAC) is used, heparin should be given only in those patients who are at high risk for systemic emboli (. large anterior MI, atrial fibrillation, previous embolus, or known LV thrombus) (See standard dosage). Heparin should not be given <= 4 hours after fibrinolytic therapy and should be given when the aPTT is < 70 (goal aPTT 50—70 seconds). After 48 hours, consideration may be given to subcutaneous heparin administration (initial dose about 17,500 Units every 12 hours to maintain aPTT —2 times control), LMWH, or oral anticoagulants. If the patient has no risk factors and SK or APSAC is the thrombolytic that was used, therapeutic heparin is not recommended.