Cardiac catheterization

PCI or intra-aortic balloon pump

Catheter patency Pediatric dosage considerations

750 U sc b.i.d. or t.i.d. for patients with history of HIT or who have low suspicion for HIT. For patients with (confirmed or strongly suspected) acute HIT with or without thrombosis, use treatment doses (see below) 2250 U iv bolusa followed by 400 U/h for 4 h, 300 U/h for 4 h, then 150-200 U/h for > 5 days, aiming for a plasma anti-Xa level of 0.5-0.8 U/mL; subcutaneous administration": 1500-2250 U sc b.i.d. Preoperative: 2250 U iv bolusa; intraoperative flushes: 750 U in 250 mL saline, using up to 50 mL; postoperative: 750 U sc t.i.d. (low-risk patients) or 150-200 U/h (high-risk patients) beginning at least 6 h after surgery 3750 U iv before first and second dialyses; 3000 U for third dialysis; then 2250 U for subsequent dialyses, aiming for plasma anti-Xa level of < 0.3 U/mL predialysis, and 0.5-0.8 U/mL during dialysis. 2250 U iv bolus, followed by 400 U/h for 4 h, then 300 U/h for 4 h, then 150-400c U/h aiming for a plasma anti-Xa level of 0.5-0.8 U/mL 125 U/kg iv bolus after thoracotomy; 3 U/mL in priming fluid of apparatus; 7 U/kg/h iv infusion commencing after CPB hookup, and continued until 45 min before expectation of stopping CPB Preprocedure: 2250 U iv bolus (3000 U if 75-90 kg and

3750 U if > 90 kg) Preprocedure: bolus as per foregoing

Postprocedure: 150-200 U/h for 1-2 days post-PCI (or until removal of balloon pump) 750 U in 50 mL saline, then 5-10 mL per port, or as required Refer to Bidlingmaier et al., 2006 (see Chapter 13 for full reference); see also Chapter 20

Note: Compatibility with intravenous solutions: Danaparoid is compatible for dilution with the following solutions: saline, dextrose, dextrose—saline, Ringer's, lactated Ringer's, 10% mannitol. Preparation of solution for infusion: One option is to add four ampules containing 3000 U (i.e., 750 anti-Xa U/0.6 mL ampule) of danaparoid to 300 mL of intravenous solution, i.e., a solution that comprises 10 U danaparoid per milliliter of intravenous solution: thus, an infusion rate of 40 mL/h corresponds to a dose of 400 U/h: 20 mL/h to a dose of 200 U/h, and so on. aAdjust iv danaparoid bolus for body weight: <60 kg, 1500 U; 60-75 kg, 2250 U; 75-90 kg, 3000 U; >90 kg, 3750 U.

bDanaparoid should be given iv during the acute (thrombocytopenic) phase of HIT (see above). cInitially up to 600 U/h may be only required if the filter has recently shown excessive clotting. Once filter life is restored to normal, the rate can be lowered.

Abbreviations: b.i.d., twice daily; b.w., body weight; CPB, cardiopulmonary bypass surgery; CRRT, continuous renal replacement therapy; HIT, heparin-induced thrombocytopenia; iv, intravenous; PCI, Percutaneous coronary intervention; t.i.d., three times daily; VTE, venous thromboembolism.

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