McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 4 8 Drugs affecting blood coagulation

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 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 Treatment of MI, acute pulmonary embolism and acute ischaemic stroke; restoration of function in occluded central venous access devices Treatment of coronary artery thrombosis associated with an acute MI Treatment of coronary artery thrombosis, PE, DVT, arterial thrombosis or embolism and to open occluded atrioventricular cannulae

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

Thrombolytic agents alteplase (Actilyse)

100 mg IV given over 2 hours

reteplase (Rapilysin)

10 International Units + 10 International Units double-bolus IV, each over 2 minutes, 30 minutes apart 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

streptokinase (Streptase)

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 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 abdominal surgery or hip replacement; treatment of unstable angina and non-Q-wave MI 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

enoxaparin (Clexane)

tinzaparin (Innohep)

175 anti-X a

International Units/kg per day SC

Treatment of acute DVT or PE in conjunction with warfarin

for 6 days or longer

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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