Drotrecogin

INTRODUCTION

Indications

To reduce mortality in adult patients with sepsis.

Action

Probably acts by suppressing widespread inflammation associated with sepsis. Therapeutic Effects: Decrease mortality due to sepsis.

Adverse Reactions/Side Effects

Hemat: BLEEDING.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure). Notify physician or nursing staff immediately if this drug causes excessive anticoagulation.

Interventions

Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

Patient/Client-Related Instruction

• Instruct patient to immediately report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Patients with a high risk of bleeding, including those with active internal bleeding, recent (within 3 mo) stroke, recent (within 2 mo) intracranial or intraspinal injury or severe head trauma, any trauma associated with an increased risk of life-threatening bleeding, presence of an epidural catheter, intracranial neoplasm/mass lesion/cerebral herniation; Patients not expected to survive due to preexisting medical condition(s); HIV-positive patients with CD4 cell counts ≤50/mm³; Chronic dialysis patients; Patients who have undergone bone marrow, lung, liver, pancreas, or small bowel transplantation; OB: Lactation.

Use Cautiously in: Concurrent therapeutic heparin therapy (≥15 units/kg/hr), recent (within 3 days) thrombolytic therapy, recent (within 7 days) oral anticoagulants or glycoprotein IIb/IIIa inhibitors, recent (within 7 days) aspirin therapy >650 mg/day or other platelet inhibitors; Platelet count <30,000 × 10⁶/L; Prothrombin time—INR >3; Recent (within 6 wk) GI bleeding; Recent (within 3 mo) ischemic stroke; Intracranial arteriovenous malformation or aneurysm; Known bleeding diathesis; Chronic severe hepatic disease; Any other serious bleeding risk; Surgical procedures (discontinue 2 hr before; resume 12 hr after if hemostasis is achieved); OB: Pregnancy (use only if clearly needed); Pedi: Children (safety not established).

Interactions

Drug-Drug: Risk of serious bleeding may be ↑ by antiplatelet agents, anticoagulants, thrombolytic agents, or other agents that may affect coagulation.

Drug-Natural: Risk of bleeding may be ↑ by arnica, chamomile, clove, dong quai, ...