Anticoagulant |
Class |
Indication |
Dose |
Reversal Agent |
Onset |
Duration |
Cost |
LOVENOX (Enoxaparin) |
LMWH |
DVT prophylaxis, DVT
treatment, Acute coronary syndromes |
DVT Prophylaxis: 30 mg SQ Q12h or 40 mg SQ daily. DVT Treatment: 1 mg/kg/dose SQ Q12h or 1.5 mg/kg/dose SQ once
daily. Bridge until therapeutic on warfarin. PCI: Balloon inflation occurring < 8 hours
after last Lovenox dose, no more doses needed. Balloon
inflation occurring 8-12 hours after last Lovenox
dose, a single IV dose of 0.3 mg/kg should be given. |
Protamine Sulfate:
See back for dosing and directions. |
SQ dosing (antifactor Xa and antithrombin):
3-5 hours |
40 mg dose (antifactor Xa activity): ~12 hours |
Enoxaparin: 30mg/0.3mL: $23.99 40mg/0.4mL: $30.99 Lovenox: 30mg/0.3mL: $259.99 40mg/0.4mL: $354.23 |
UFH |
Anticoagulant |
Prophylaxis and treatment
of thromboembolic disorders |
DVT Prophylaxis: 5000 units SQ Q8-12h DVT/PE treatment: 80 units/kg IV push followed by 18 units/kg/hr
continuous infusion. |
Protamine Sulfate:
See back for dosing and directions. |
IV dosing: Immediate SQ dosing: ~20-30 minutes |
SQ: ~8 hours |
Heparin Solution: 1000
units/mL(10): $188.99 10,000 units/mL (5): $29.99 |
COUMADIN (Warfarin) |
Vitamin K Antagonist |
Prophylaxis and treatment
of thromboembolic disorders and embolic
complications arising from Afib or cardiac valve
replacement. |
Dosing is patient
specific. Usual starting dose is
5-10 mg |
Mephyton, Fresh Frozen Plasma, OR Alphanine SD/Benefix: See back for dosing/directions. |
24-72 hours |
2-5 days |
Warfarin tablets: 2 mg (30): $14.99 5 mg (30): $13.99 10 mg (30): $24.99 |
(Fondaparinux) |
Factor Xa Inhibitor |
Prophylaxis and treatment
of DVT; Treatment of PE |
DVT Prophylaxis: Adults > 50 kg: 2.5 mg SQ once daily. Acute DVT/PE Treatment: 5 mg SQ once daily (< 50kg); 7.5 mg SQ once
daily (50-100 kg); 10 mg SQ once daily (>100 kg). Bridge until therapeutic
on warfarin. |
Novoseven: See
back for dosing/directions. |
Peak: 2-3 hours |
3-4 days |
Arixtra Solution: 2.5mg/0.5mL (5): $593.04 7.5mg/0.6mL (0.6):$140.09 |
XARELTO (Rivaroxaban) |
Factor Xa Inhibitor |
Postoperative thromboprophylaxis in patients who have undergone hip or
knee replacement surgery. |
Postoperative thromboprophylaxis: Knee replacement: 10 mg Hip replacement: 10 mg *Note* Do
not initiate therapy until >6-10 hours post surgery & hemostasis has been established. |
Hold drug 1-2 days prior to
surgery. Fresh Frozen Plasma: See back for dosing & directions. Activated Charcoal if taken
within 2 hours. PCC: see
back for dosing. |
Peak: 2-4 hours |
~35 hours |
|
PRADAXA (Dabigatran) |
Thrombin Inhibitor |
Prevention of stroke and
systemic embolism in patients with non-valvular Afib. |
150 mg |
Hold drug 1-2 days prior to
surgery. Fresh Frozen Plasma: See back for dosing & directions. Activated Charcoal if taken
within 2 hours. Maintain adequate diuresis;
consider hemodialysis if feasible. |
Peak: 1 hour (delayed 2 hours by food) |
2.5-3.5 days |
|
Antidote |
Class |
Indication |
Dose |
Onset |
Duration |
Cost |
Protamine Sulfate |
Antidote |
LMWH or UFH toxicity, or
for hemorrhage associated with UFH or LMWH therapy |
LMWH administered within
8 hours: 1 mg of protamine sulfate to neutralize 1 mg enoxaparin
LMWH administered
greater than 8 hours prior or if aPTT prolonged
after 2-4 hours after first infusion: 0.5 mg protamine
per 1 mg of enoxaparin UFH toxicity: 1 mg IV
for every 100 units of heparin to be neutralized Neutralization of UFH
during cardiac surgery: 1.5 mg IV for every 100 units of
heparin administered |
5 minutes *Anti-Factor Xa activity is
never completely neutralized (maximum: 60%) |
Can persist up to 2 hours,
depending on body temperature |
|
Fresh Frozen Plasma |
Blood Product |
Severe warfarin
overdosage |
Give FFP at about 10 mL/minute, to a total dose of about 5 – 8 mL/kg *Should be ABO compatible |
30 minutes |
2 – 4 hours |
|
MEPHYTON (Vitamin
K/Phytonadione) |
Fat Soluble Vitamin |
Rapid reversal required for
surgery |
vitamin K1
orally 2-4 mg and hold warfarin |
Oral: 6-10 hours IV: 1-2 hours |
12 – 24 hours |
5 mg tablets (30): $251.96 |
AMICAR (Aminocaproic Acid) |
Hemostatic agent |
For the treatment of
hemorrhage caused by hyperfibrinolysis; and for
surgical bleeding prophylaxis or treatment |
Oral: 5 gm PO
first hour, then 1-1.25 gm/hour PO for 8 hours or until therapeutic response IV: Loading
dose of 4-5 gm IV over 1 hour, then continuous infusion at 1 gm/hour IV for 8
hours or until therapeutic response |
1-72 hours Peak: within 2 hours |
3 – 4 hours |
Amicar Tablets:
5gm(30): $103.39 Aminocaproic Acid Tablets: 5gm(100): %186.47 |
Novoseven |
Antihemophilic Agent; Blood Product Derivative |
Reversal of fondaparinux or oral anticoagulation therapy |
90 mcg/kg as single IV
bolus |
Minutes Peak: 30 minutes |
2 – 6 hours |
|
Alphanine SD/Benefix
(Factor IX Concentrate) |
Antihemophilic Agent; Blood Product Derivative |
Treatment of warfarin toxicity or reversal of warfarin
anticoagulant therapy in patients with hemorrhage |
INR < 3.5 and
life-threatening bleed or urgent surgery: 35 IU/kg IV once INR 3.5 – 6: 35
IU/kg IV once INR greater than or
equal to 6: 50 IU/kg IV once |
10 – 30 minutes |
18 – 30 hours |
|
Evithrom/Thrombin-JMI/Recothrom (Topical Thrombin) |
Hemostatic Agent |
Hemostasis of small vessels and capillaries associated with
surgical bleeding |
Apply solution topically
for bleeding from skin or mucosal surfaces |
Immediate |
< 5 minutes |
|
DDAVP (Desmopressin) |
Antihemophilic/Hemostatic Agent; Vasopressin Analog |
For patients with acquired
(drug-induced platelet dysfunction) reflected by prolonged bleeding time |
0.3 mcg/kg (range: 0.2 – 0.4 mcg/kg/dose) IV/SC |
30 minutes (dose related) |
~ 8-12 hours |
4mcg/mL (1): $59.30 4mcg/mL (10): $473.06 |
Prothrombin Complex Concentrate (PCC) |
Antihemophilic Agent; Blood Product Derivative |
|
IV: 150 IU/Kg |
Immediate (in case study
with rivaroxaban) |
Sustained for 24 hours (in
case study) |
|