Note: Limited data available dosing regimens not established.
Infants and children 16 years or younger: Initial: 0.5 mcg/kg/min administered as a constant infusion. No adjustment recommended Liver Dose Adjustments This precaution is based on adult studies of patients with these disease states who had reduced argatroban clearance. Note: A lower initial infusion rate may be needed in other pediatric patients with reduced clearance of argatroban (e.g., patients with heart failure, multiple organ system failure, severe anasarca, or postcardiac surgery). Maintenance dose: Measure aPTT after 2 hours adjust dose until the steady-state aPTT is 1.5 to 3 times the initial baseline value, not exceeding 100 seconds adjust in increments of 0.1 to 0.25 mcg/kg/minute for normal hepatic function reduce dose in hepatic impairment (see liver dose adjustment). Initial dose: 0.75 mcg/kg/minute by continuous IV infusion If argatroban therapy is used concurrently with or following FFP or a thrombolytic, some centers decrease dose by half. Additionally, during the course of treatment, patient's dosing requirements may change as clinical status changes (e.g., sicker patients require lower dose) frequent dosage adjustments may be required to maintain desired anticoagulant activity. For specific uses, required maintenance dose is highly variable between patients. Titration of maintenance dose must consider multiple factors including current argatroban dose, current aPTT, target aPTT, and clinical status of the patient. Infants and Children 16 years or younger: The safety and effectiveness of argatroban, including the appropriate anticoagulation goals and duration of therapy, have not been established among pediatric patients. Usual Pediatric Dose for Thrombotic/Thromboembolic Disorder Once a therapeutic ACT (between 300 and 450 seconds) has been achieved, this infusion dose should be continued for the duration of the procedure. If the ACT is greater than 450 seconds, the infusion rate should be decreased to 15 mcg/kg/min, and the ACT checked 5 to 10 minutes later. If the ACT is less than 300 seconds, an additional IV bolus dose of 150 mcg/kg should be administered, the infusion dose increased to 30 mcg/kg/min, and the ACT checked 5 to 10 minutes later. The procedure may proceed if the ACT is greater than 300 seconds.
Activated clotting time (ACT) should be checked 5 to 10 minutes after the bolus dose is completed. Initial: 25 mcg/kg/min infusion and a bolus of 350 mcg/kg administered via a large bore intravenous line over 3 to 5 minutes. Percutaneous Coronary Interventions (PCI) in HIT/HITTS patients: Dosage adjustments should be based on aPTT results from blood samples obtained at least 2 hours after the most recent infusion rate change. Maintenance: The infusion rate may be adjusted as needed (not to exceed 10 mcg/kg/min) until the steady state aPTT value is 1.5 to 3 times the initial baseline value (not to exceed 100 seconds). Begin infusion only after obtaining a baseline activated partial thromboplastin time (aPTT). Initial: 2 mcg/kg/min administered as a constant infusion. Heparin-induced thrombocytopenic (HIT) thrombosis treatment or prophylaxis: Usual Adult Dose for Thrombotic/Thromboembolic Disorder
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