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Monitored by ECT: >2.5 mg/mL before start of CPB; 3.5-4.5 mg/mL during CPBh

Note: Repeat aPTT determinations should be made 4-6 h after any dose adjustment. aA maximum body weight of 100 kg should be used for dose calculations. bAdjust for renal insufficiency.

cThe ratio is based on comparison with the normal laboratory mean aPTT. If Actin FS or Neothromtin reagents are used, the aPTT target range is usually 1.5-3.0.

dThis is the author's recommended starting dose in all HIT patients, unless life-or limb-threatening thrombosis is present.

fTested in a prospective, randomized trial after orthopedic surgery with desirudin (Eriksson et al., 1996, 1997). gStop 15 min before and of CPB; put 5 mg into CPB after disconnection to avoid clotting of pump. hThe target lepirudin level pre-CPB (>2.5 mg/mL) is lower than the level sought during CPB (3.4-4.5 mg/mL) because of the addition of lepirudin to the pump priming fluid (0.2 mg/kg b.w.).

Abbreviations: aPTT, activated partial thromboplastin time; b.w., body weight; CPB, cardiopulmonary bypass; CVVH, continuous venovenous hemofiltration; ECT, ecarin clotting time; iv, intravenous; MI, myocardial infarction; PCI, percutaneous coronary intervention; UA, unstable angina. Source: See Chapter 14 for references cited.

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