Lepirudin (Rdna)

INTRODUCTION

Indications

Management of thromboembolic disease and prevention of its complications in patients who have experienced heparin-induced thrombocytopenia.

Action

Acts as an anticoagulant by inhibiting the action of thrombin. Produced by recombinant DNA technology. Therapeutic Effects: Anticoagulation with prevention of thromboembolic complications.

Adverse Reactions/Side Effects

Hemat: BLEEDING. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

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 of these signs.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

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 immediately to 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: Distributes mainly to extracellular fluids.

Metabolism and Excretion: Metabolized by release of amino acids caused by breakdown of drug; 48% excreted unchanged in urine.

Half-life: 1.3 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity.

Use Cautiously in: Recent puncture of large vessels/organ biopsy; Vessel/organ anomaly; Recent CVA, stroke, intracerebral surgery or other neuroaxial procedure; Severe uncontrolled hypertension; Severe renal impairment (CCr <15 mL/min); Bacterial endocarditis ; Hemorrhagic diatheses; Recent major surgery; Recent major bleeding; Severe liver impairment; Moderate renal impairment (reduced bolus and maintenance infusion rate recommended if CCr 15 <50 mL/min); Pregnancy, lactation or children (safety not established).

Interactions

Drug-Drug: ↑ risk of bleeding with thrombolytic agents, NSAIDs, valproic acid, cefotetan, cefoperazone, platelet aggregation inhibitors, including aspirin, dipyridamole, clopidogrel, ticlopidine, tirofiban, and eptifibatide.

Route/Dosage

IV (Adults): 0.4 mg/kg (not to exceed 44 mg) as a bolus over 15–20 sec, followed by 0.15 mg/kg/hr (not to exceed 16.5 mg/hr) initially; further adjustments made on the basis of laboratory assessment (aPTT) but should not exceed infusion rate of 0.21 mg/kg/hr without checking for coagulation ...