Approved Hospital Formulary
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Approved Hospital Formulary
Anticoagulation Reversal Table
Drug

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 PO daily for 1-2 days. Adjust dose according to INR results. May want to start at 2-5 mg PO daily for selected patients (consider age, risk of bleeding, etc.) Usual maintenance dose ranges from 2-10 mg PO daily.

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

 


ARIXTRA

(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 PO once daily for 12-14 days.

Hip replacement: 10 mg PO once daily for 35 days.

*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 PO twice daily

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)

 

 

Pharmacy Phone Numbers
Memorial Pharmacy (Glenwood) 423-495-8380
Memorial Hixson Pharmacy 423-495-7137
Stat 423-495-7470
Outpatient 423-495-8981
Chemo 423-495-7475
Surgery 423-495-8779

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