C H A P T E R 4 8
Drugs affecting blood coagulation
757
TABLE 48.1
DRUGS IN FOCUS Drugs affecting clot formation and resolution (continued)
Drug name
Dosage/route
Usual indications
Anticoagulants (continued)
rivaroxaban (Xarelto)
10 mg PO once daily
Prevention of thromboembolic events in
individuals who have undergone elective
total hip or total knee replacement;
prevention of stroke and embolism in
individuals with atrial fibrillation and one
or more risk factors; prevention of DVT
and pulmonary embolism
warfarin (Coumadin,
Marevan)
10–15 mg/day PO, then 2–10 mg/day PO
based on PT ratio or INR; use lower doses
with geriatric people
Treatment of people with atrial fibrillation,
artificial heart valves or valvular damage
that makes them susceptible to thrombus
and embolus formation; prevention
and treatment of venous thrombosis,
pulmonary embolus, embolus with atrial
fibrillation, systemic emboli after MI
Thrombolytic agents
alteplase (Actilyse)
100 mg IV given over 2 hours
Treatment of MI, acute pulmonary
embolism and acute ischaemic stroke;
restoration of function in occluded central
venous access devices
reteplase (Rapilysin)
10 International Units + 10 International
Units double-bolus IV, each over 2 minutes,
30 minutes apart
Treatment of coronary artery thrombosis
associated with an acute MI
streptokinase (Streptase)
250,000 International Units over 30 minutes,
then 100,000 International Units/hour IV
for 24–72 hours for pulmonary embolism
(PE), DVT, arterial thrombosis, or embolism;
250,000 International Units in 2-mL IV
solution to clear cannulae
Treatment of coronary artery thrombosis,
PE, DVT, arterial thrombosis or embolism
and to open occluded atrioventricular
cannulae
tenecteplase (Metalyse)
30–50 mg IV over 5 seconds
Reduction of mortality associated with
acute MI
Other drugs affecting clot formation
Low-molecular-weight heparins
dalteparin (Fragmin)
DVT: 2500–5000 International Units/d SC
starting 1–2 hours before surgery and then
for 5–10 days
Angina: 120 International Units/kg SC
q 12 hours with aspirin therapy for 5–8 days
Prevention of DVT that may lead to
PE after abdominal surgery or hip
replacement; treatment of unstable
angina and non-Q-wave MI
enoxaparin (Clexane)
Hip surgery: 30 mg SC q 12 hours for
7–10 days
Abdominal surgery: 40 mg/day SC for
7–10 days DVT or PE: 1 mg/kg SC q 12 hours
Angina: 1 mg/kg SC q 12 hours
Prevention of DVT in high-risk people:
40 mg/day SC for 6–14 days
Prevention of DVT that may lead to PE
after hip replacement or abdominal
surgery; with warfarin to treat acute
DVT or PE; prevention of ischaemic
complications of unstable angina or
non-Q-wave MI; prevention of DVT in
people with severely restricted mobility
due to illness
tinzaparin (Innohep)
175 anti-X
a
International Units/kg per day SC
for 6 days or longer
Treatment of acute DVT or PE in
conjunction with warfarin
Anticoagulant adjunctive therapy
lepirudin (Refludan)
0.4 mg/kg as an IV bolus followed by
continuous IV infusion of 0.15 mg/kg for
2–10 days
Treatment of heparin-induced
thrombocytopenia associated with
thromboembolic disease (rare allergic
reaction to heparin)
protamine sulfate
1 mg IV neutralised 90–115 USP units of
heparin; dose based on specific overdose
Treatment of heparin overdose
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