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| Bolus: None <br> Continuous infusion: <br>
| Bolus: None <br> Continuous infusion: <br>
: ♦ Normal organ function - 2 μg/kg per minute  
: ♦ Normal organ function: 2 μg/kg per minute  
: ♦ Liver dysfunction (total serum bilirubin 1.5 mg/dL), heart failure, postcardiac surgery, anasarca - 0.5-1.2 μg/kg per minute
: ♦ Liver dysfunction (total serum bilirubin 1.5 mg/dL), heart failure, postcardiac surgery, anasarca: 0.5-1.2 μg/kg per minute


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| Bolus:0.2 mg/kg (only for life- or limb-threatening thrombosis) <br> Continuous infusion: <br>
| Bolus:0.2 mg/kg (only for life- or limb-threatening thrombosis) <br> Continuous infusion: <br>
: ♦ Cr < 1.0 mg/dL - 0.10 mg/kg per hour
: ♦ Cr < 1.0 mg/dL: 0.10 mg/kg per hour
: ♦ Cr 1.0-1.6 mg/dL - 0.05 mg/kg per hour
: ♦ Cr 1.0-1.6 mg/dL: 0.05 mg/kg per hour
: ♦ Cr 1.6-4.5 mg/dL - 0.01 mg/kg per hour
: ♦ Cr 1.6-4.5 mg/dL: 0.01 mg/kg per hour
: ♦ Cr > 4.5 mg/dL - 0.005 mg/kg per hour
: ♦ Cr > 4.5 mg/dL: 0.005 mg/kg per hour


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| Bolus: None <br> Continuous infusion: <br>
| Bolus: None <br> Continuous infusion: <br>
: ♦ Normal organ function - 0.15 mg/kg per hour
: ♦ Normal organ function: 0.15 mg/kg per hour
: ♦ Renal or hepatic dysfunction - dose reduction may be appropriate
: ♦ Renal or hepatic dysfunction: dose reduction may be appropriate




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| Bolus: <br>
| Bolus: <br>
: ♦ < 60 kg - 1500 U
: ♦ < 60 kg: 1500 U
: ♦ 60-75 kg - 2250 U
: ♦ 60-75 kg: 2250 U
: ♦ 75-90 kg - 3000 U
: ♦ 75-90 kg: 3000 U
: ♦ > 90 kg - 3750 U <br>
: ♦ > 90 kg: 3750 U <br>
Accelerated initial infusion: 400 U/hour X 4 hours, then 300 U/hour X 4 hours <br>
Accelerated initial infusion: 400 U/hour X 4 hours, then 300 U/hour X 4 hours <br>
Maintenance infusion: <br>
Maintenance infusion: <br>
: ♦ Normal renal function - 200 U/hour
: ♦ Normal renal function: 200 U/hour
: ♦ Renal insufficiency - 150 U/hour
: ♦ Renal insufficiency: 150 U/hour


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Revision as of 16:19, 2 January 2014



Agent Dosage
Direct FXa inhibitors
Argatroban Bolus: None
Continuous infusion:
♦ Normal organ function: 2 μg/kg per minute
♦ Liver dysfunction (total serum bilirubin 1.5 mg/dL), heart failure, postcardiac surgery, anasarca: 0.5-1.2 μg/kg per minute
Lepirudin Bolus:0.2 mg/kg (only for life- or limb-threatening thrombosis)
Continuous infusion:
♦ Cr < 1.0 mg/dL: 0.10 mg/kg per hour
♦ Cr 1.0-1.6 mg/dL: 0.05 mg/kg per hour
♦ Cr 1.6-4.5 mg/dL: 0.01 mg/kg per hour
♦ Cr > 4.5 mg/dL: 0.005 mg/kg per hour
Bivalirudin Bolus: None
Continuous infusion:
♦ Normal organ function: 0.15 mg/kg per hour
♦ Renal or hepatic dysfunction: dose reduction may be appropriate


Indirect FXa inhibitors
Danaparoid Bolus:
♦ < 60 kg: 1500 U
♦ 60-75 kg: 2250 U
♦ 75-90 kg: 3000 U
♦ > 90 kg: 3750 U

Accelerated initial infusion: 400 U/hour X 4 hours, then 300 U/hour X 4 hours
Maintenance infusion:

♦ Normal renal function: 200 U/hour
♦ Renal insufficiency: 150 U/hour