Treatment of deep vein thrombosis and pulmonary embolism:IV: Loading dose: 5000–10 000 units —then a continuous intravenous infusion of 18 units/kg/hourTreatment of deep vein thrombosis: SC: 15 000 units every 12 hours, dose —is adjusted according to laboratory monitoringProphylaxis: 5000 units every 8–12 hours or according to local protocols
20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function
<10           : Dose as in normal renal function
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Not dialysed. Dose as in normal renal function
HD                     :Not dialysed. Dose as in normal renal function
HDF/high flux   :Not dialysed. Dose as in normal renal function
CAV/VVHD      :Not dialysed. Dose as in normal renal function
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Analgesics: increased risk of bleeding with NSAIDs – avoid concomitant use with IV diclofenac; increased risk of haemorrhage with ketorolac – avoid concomitant use
Nitrates: anticoagulant effect reduced by infusions of glyceryl trinitrateDrotrecogin alfa: manufacturer advises to avoid use of high doses of heparin with drotrecogin alfaUse with care in patients receiving oral anticoagulants, platelet aggregation inhibitors, aspirin or dextran
ADMINISTRATION
Reconstition
–
Route
IV infusion
or bolus, SC
Rate of Administration
18 units/kg/hour, or according to local protocol
Comments
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OTHER INFORMATION
Half-life is slightly prolonged in haemodialysis patients after intravenous administrationAlso used for the maintenance of extracorporeal circuits in cardiopulmonary bypass and haemodialysis1 mg protamine is required to neutralise 100 IU heparin; give slowly over 10 minutes, and do not exceed a total dose of 50 mgTo reduce or prevent fibrin formation in patients on PD, heparin may be added to PD fluid at a concentration of 1000 IU/L.