Anticoagulation

Card Set Information

Author:
adguvetis
ID:
162129
Filename:
Anticoagulation
Updated:
2012-07-11 17:29:32
Tags:
Pharmacy
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Description:
Naplex
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  1. Heparin dosing
    • Prophylaxis: 5000 U SC Q8-12H
    • Treatment: 80 U/kg bolus; 18 U/kg/hr infusion
    • ACS: 60 U/kg bolus; 12 U/kg/hr infusion 
  2. Heparin antidote
    Protamine
  3. Enoxaparin prophylaxis dosing
    • 30 mg SC Q12H or 40 mg SC daily
    • CrCl < 30ml/min: 30 mg SC daily 
  4. Enoxaparin treatment dosing
    • 1mg/kg SC Q12H or 1.5mg/kg SC daily
    • CrCl < 30ml/mmin: 1 mg/kg SC daily 
  5. May cause osteoporosis with long term use
    Heparin
  6. Selectively inhibits Factor Xa
    • Fondaparinux (SC)
    • Rivaroxaban (PO) 
  7. Direct thrombin inhibitors
    • Lepirudin (IV)
    • Argatroban (IV)
    • Bivalirudin (IV)
    • Dabigatran (PO) 
  8. Dabigatran dosing
    150mg BID; 75mg BID if CrCl 15-30 ml/min
  9. INR < 5.0 with no significant bleeding
    Lower dose or omit dose, monitor more frequently
  10. INR >= 5.0 but < 9.0 and no significant bleeding
    • Omit 1-2 doses, monitor more frequently OR
    • Omit 1 dose and give PO Vitamin K 1-2.5mg 
  11. INR >= 9.0 and no significant bleeding
    Hold warfarin, give PO Vitamin K 2.5-5mg
  12. Serious bleeding and elevated INR
    Hold warfarin and give 10mg Vitamin K by slow IV infusion

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