Category:

• Miscellaneous

Description:

• Anticoagulant

Indications:

• Venous thrombosis, pulmonary embolism, peripheral arterial embolism

• Coagulopathies, DVT/PE prophylaxis, clotting prevention in arterial and heart surgery

• Blood transfusions, extracorporeal circulation, dialysis and blood samples

Contraindications:

• Severe thrombocytopenia, uncontrolled bleeding (except when due to DIC)

• Suspected intracrainial hemorrhage, shock, severe hypotension

Precautions:

• Pregnancy category C; does not cross placental barrier; not excreted in breast milk

• IM injection (avoid due to risk for hematoma)

• Elderly, children, diabetes,  renal insufficiency, severe hypertension

• Subacute bacterial endocarditis, acute nephritis, peptic ulcer disease, sever renal disease

Adverse Reactions (Side Effects):

• CNS: fever, rash

• CV: allergic vasospastic reactions, shock

• EENT: lacrimation, rhinitis

• GI: nausea, vomiting

• GU: hematuria, priapism

• HEME: hemorrhage, thrombocytopenia, white clot syndrome

• RESP: anaphylactoid reactions, asthma

• SKIN: chills, cutaneous necrosis, delayed transient alopecia, erythema, histamine-like reactions, local irritation, urticaria

Dosage:

Administered SC and IV

• Adult:            

  • DVT/PE: 

    • IV INF 50-100 u/kg initially, then 15-25 u/kg/hr, adjusted based on APTT results; intermittent IV 10,000u initially, then 75-125 u/kg every 4-6 hours

    • SC 10,000-20,000u initially, then 8,000-10,000u every 8 hours or 15,000-20,000u every 12 hours

  • Prevent DVT/PE: 

    • SC 5000u every 8-12 hours until patient is ambulatory

• Child:   

  • IV INF 50 u/kg initially, then 15-25 u/kg/hr, increase dose by 2-4 u/kg/hr every 6-8 hours based on aPTT results

  • Intermittent IV 50-100 u/kg initially, then 50-100 u/kg every 4 hours