Adult Dosing
Prophylaxis hip replacement surgery
- 15 mg q12hrs SC with the initial dose 5-15 min prior to surgery
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Moderate (31 to 60 CrCl) Initial dose 5 mg q12hrs SC
- Severe (<31 CrCl) Initial dose 1.7 mg q12hrs
Note:
- Monitor aPTT and serum creatinine daily
- If aPTT exceeds 2 times control therapy until the value returns to less than 2 times control: Consider further dose reductions by the initial degree of aPTT abnormality
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined; caution advised
- When neuraxial anesthesia or spinal puncture is initiated to patient while on selective inhibitors of thrombin they are at risk of developing an epidural or spinal hematoma which lead to long-term or permanent paralysis, risk increases by the use of indwelling spinal catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, anticoagulants, and traumatic, epidural or spinal puncture (US Black Box warning)
- Consider the potential benefit versus risk before neuraxial intervention in thromboprophylaxis when patients is anticoagulated or to be anticoagulated (US Black Box warning)
- Monitoring of aPTT, serum creatinine and dose reduction factors are recommended for patients with moderate and severe renal impairment
- Bleeding can occur at any site during therapy
- While scheduling or using epidural or spinal anesthesia the pharmacokinetic profile of the drug should be considered
- Before initiating desirudin physician should consider placement of the catheter also removal of the catheter should be consider when the anticoagulant effect of desirudin is low
- Patients should inform their physician immediately if they experience signs or symptoms of neurological impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), bowel and bladder dysfunction, If sign of spinal hematoma are suspected urgent diagnosis and treatment including spinal cord decompression should be given
Cautions: use cautiously in
- Hepatic impairment
- Bleeding risk
- Major surgery
- Increased risks of hemorrhage
- Organ biopsy or puncture
- History of hemorrhagic stroke
- Intracranial bleeding
- Intraocular bleeding
- Diabetic retinopathy
- Ischemic stroke
- Hemostatic disorder
- Severe uncontrolled hypertension
- Bacterial endocarditis
- Gastrointestinal bleeding
- Pulmonary bleeding
- Epidural or spinal anesthesia
Pregnancy Category:B
Breastfeeding: Safety unknown: Manufacturer advises caution.
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