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|
| Strengths/Mixed: (in D5W) |
| 1X: 1.5 mg/ml or 150 mg/ 100ml (LD soln) |
| 2X: 1.8 mg/ml or 360 mg/ 200 ml (MD soln) 2X: 1.8 mg.ml or 450 mg/ 250 ml (MD soln) |
| Acute MI: |
| ADULT |
| BD: 0.25 mg/kg MD: 0.5 mg/kg/hr x 12 hrs, 0.25 mg/kg/h x 36 hrs Concomitant Rx: Steptokinase 1.5 million units over 30-60 min Continue fibrinolysis 48 hrs to Revascularization or 8 days |
| HIT: |
| Adult: |
| Acute w or w/o Thrombosis: |
| 0.15 mg/kg/hr - adjust PTT 1.5-2.5 of normal |
| Heart Operation: |
| BD: 1 mg/kg IV |
| MD: 2.5 mg/kg/hr with 50 mg in pump prime |
| Target: ACT 2.5x Baseline ACT |
| PTCA |
| BD: 0.75 mg/kg, ACT before BD#2 |
| MD: 1.75 mg/kg/hr during procedure |
| BD#2: 0.3 mg/klg after 5 minutes |
| MD#2: 1.75 mg/kg/hr x 4hrs if STEMI |
| If Pretreated with unfractionated heparin: |
| After 30 min: BD: 0.75 mg/kg |
| If Pretreated with Enoxaprin: |
| Full Dose (see above) |
| If Pretreated with LMWH: |
| NSTEMI: wait 8 hrs |
| Glygoprotein IIb/IIIa inhibitor concomitant Rx not recommended |
| Thrompoembolism Disorder: |
| LD: 1 mg/kg MD: 0.25 mg/kg/hr until PCI then do PCI dosing |
| If Pretreated with unfractionated heparin: |
| Wait 30 min |
| If Pretreated with Enoxaprin: |
| Wait 8 hrs |
| PEDI 6 mo-18 y.o. |
| LD: 0.125 mg/kg MD: 0.125 mg/kg/hr - target PTT 1.5-2.5 of normal |
| Dose Adustment |
| CrCl < 30 ml/min: MD: 1 mg/kg/hr |
| Hemodialysis: 0.25 mg/kg/hr, No Bolus Obesity: For HIT - use total body weight |
| Precuations |
| Bleeding Hypersensitivy Rxn Thrombus Contraindication: Defibrotide |
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