Heparin Injection

Total Page:16

File Type:pdf, Size:1020Kb

Heparin Injection HEPARIN INJECTION Consumer Medicine Information What is in this leaflet formed from becoming larger and any other medicine causing serious problems. any other substances, such as This leaflet answers some common Heparin Injection is used for foods, preservatives or dyes questions about Heparin Injection. It prevention and treatment of diseases 2. you are pregnant or intend to does not contain all the available caused by blood clots such as in become pregnant information. It does not take the certain blood vessel, heart and lung place of talking to your doctor or conditions. It is also used to prevent your doctor will discuss the possible risks and benefits of pharmacist. blood clots from forming during being given heparin during surgery, dialysis or blood All medicines have benefits and pregnancy. risks. Your doctor has weighed the transfusions. 3. you are breast-feeding or plan risks of you using Heparin Injection Heparin Injection may be used for against the benefits this medicine is the treatment of other conditions that to breast feed expected to have for you. are not mentioned above. Your your doctor will discuss the This medicine is likely to be used doctor will be able to tell you about possible risks and benefits of being given heparin whilst while you are at the clinic or in the specific condition for which you breastfeeding. hospital. If possible, please read this have been prescribed Heparin leaflet carefully before this medicine Injection. 4. you have or have had any is given to you. In some cases this This medicine is available only with medical conditions or leaflet may be given to you after the a doctor's prescription. procedures, especially the medicine has been used. following: If you have any concerns about heart problems or high blood using this medicine, ask your pressure doctor or pharmacist. Before you are given blood disease or bleeding Keep this leaflet. HEPARIN INJECTION problems You may need to read it again. heavy or unusual periods When you must not be given it medical or dental procedure stomach ulcer Do not use Heparin Injection if What HEPARIN you: liver disease INJECTION is used for have an allergy to heparin or pork kidney disease products Heparin Injection belongs to a group Taking other medicines have, or may have, a bleeding of medicines known as disease or a problem with your Tell your doctor if you are taking anticoagulants. Anticoagulants work blood vessels any other medicines, including any by decreasing the clotting ability of that you buy without a your blood and help stop clots have a low blood platelet count prescription from your pharmacy, forming in the blood vessels. If you are not sure whether any of supermarket or health food shop. Anticoagulants are sometimes called these apply to you, check with your Some medicines and heparin may "blood thinners", although they do doctor. not actually thin the blood. Heparin interfere with each other. These will not dissolve blood clots that Before you are given it include: have already formed, but it may pain relieving medicines such as Tell your doctor if: prevent any clots that have already aspirin and ibuprofen 1. you have any allergies to: HEPARIN INJECTION 1 medicines for heart and How HEPARIN telephone the Poisons Information circulation problems such as INJECTION is given Centre (in Australia, phone 13 11 26; digitalis, nitroglycerine, in New Zealand, phone 0800 dipyridamole and epoprostenol POISON or 0800 764 766) for How it is given medicines for hayfever such as advice, or go to Accident and antihistamines Heparin Injection can be injected Emergency at your nearest hospital if under the skin or into a vein. you have side effects after being medicines for rheumatoid arthritis Sometimes it may be diluted and given Heparin Injection. You may such as hydroxychloroquine given to you as a slow injection into need urgent medical attention. anti-inflammatory medicines such one of your veins (this is called an as indomethacin and intravenous infusion). Heparin phenylbutazone Injection must only be given by a nicotine doctor or nurse. While you are given anticlotting medicines such as HEPARIN INJECTION How much is given aprotinin and warfarin Things you must do medicines which cause increased Your doctor will decide what dose, volume of urine such as how often and how long you will If you are about to be started on spironolactone, triamterene and receive Heparin Injection. This any new medicine, remind your amiloride depends on your condition and other doctor and pharmacist that you factors, such as age, blood tests, potassium supplements including are being given Heparin Injection. method it is being given and whether potassium containing salt Tell any other doctors, dentists, or not other medicines are being substitutes given at the same time. and pharmacists who treat you medicines for treating gout such that you are being given this To prevent clots forming, you will as probenecid medicine. usually be given a deep injection If you are going to have surgery, medicines for reducing swelling under the skin 2 hours before surgery tell the surgeon or anaesthetist that of the body such as ethacrynic and every 8 - 12 hours for up to a acid week after surgery. This will depend you are being given this medicine. medicines for cancer treatment on your condition. It may affect other medicines used such as cytostatic drugs and To help clots that have already during surgery. asparaginase formed you will be given Heparin If you are about to have any blood antibiotics such as tetracyclines, Injection either as a continuous or tests, tell your doctor that you are cephamandole and penicillins intermittent infusion into the vein. being given this medicine. Your doctor may also choose to medicines used for epilepsy It may interfere with the results of inject Heparin Injection under the (seizures) such as valproic acid some tests. skin after giving you the first dose by medicines used for thyroid an intravenous injection. problems such as propylthiouracil substances used to enhance the If you are given too much Side effects contrast of structures or fluids (overdose) within the body in medical This rarely happens as Heparin Tell your doctor or nurse as soon imaging Injection is administered under the as possible if you do not feel well corticosteroids care of a highly trained doctor. while you are being given heparin. insulin However, if you are given too much Like other medicines, heparin can cause some side effects. If they Your doctor and pharmacist have heparin, you may experience some of occur, most are likely to be minor or more information on medicines to be the effects listed under "Side effects" careful with or avoid while using this below. temporary. However, some may be serious and need medical attention. medicine. Your doctor has information on how Your doctor will advise you about to recognise and treat an overdose. Ask your doctor or nurse to answer any questions that you may continuing to take other medicines Ask your doctor if you have any have. while you are receiving Heparin concerns. Injection. In the case of an overdose, Do not be alarmed by this list of immediately tell your doctor or possible side effects. You may not experience any of them. HEPARIN INJECTION 2 Tell your doctor or nurse as soon After using HEPARIN Australian Registration as possible if you notice any of the INJECTION Numbers following: AUST R 49232 - Heparin Injection - change in skin colour or pain Storage 5,000IU/5mL (sterile) - Steriluer® around the injection site ampoule (50's) Heparin Injection will be stored in fever the pharmacy or on the ward. The AUST R 49232 - Heparin Injection - chills injection is kept in a cool dry place, 5,000IU/5mL (sterile) - Steriluer® runny nose where the temperature stays below ampoule (10's) 25°C. watering eyes AUST R 49236 - Heparin Injection - 25,000IU/5mL (sterile) - Steriluer® nausea and vomiting ampoule (50's) headache itchy soles of the feet Product Description Date of preparation These are side effects of heparin. November 2012 What it looks like Mostly these are mild and short- lived. Heparin Injection is a clear, ® Registered trademark. Tell your doctor or nurse colourless to straw coloured solution © Copyright Pfizer Pty Ltd. immediately if you experience any in a plastic ampoule. of the following: Ingredients bleeding or bruising more easily than normal e.g. unexplained Heparin Injection contains Heparin nosebleeds, heavy periods, Sodium BP (porcine) 1000IU/mL or bleeding from gums when 5000IU/mL in sterile water. It does brushing teeth not contain a preservative. If you drink heavily you have a greater risk of bleeding compared Manufacturer to moderate drinkers or non Pfizer (Perth) Pty Limited drinkers. Elderly patients (older ABN 32 051 824 956 than 65 years of age), particularly women, have a greater risk of 15 Brodie Hall Drive, bleeding. Bentley WA 6102 Australia abdominal or stomach pain, back pain, blood in urine or stools, Supplier vomiting of blood Heparin Injection is supplied in signs of allergy such as a rash, Australia by: itching, hives on the skin, Pfizer Australia Pty Ltd swelling of the face, lips, tongue ABN 50 008 422 348 or other parts of the body, shortness of breath, wheezing or 38-42 Wharf Road trouble breathing West Ryde NSW 2114 Australia numbness, tingling or muscle Toll Free number: 1800 675 229 weakness, abnormal function or loss of control of your bowel or urine It is supplied in New Zealand by: persistent painful erection Pfizer New Zealand Limited These side effects are serious. You PO Box 3998 may need urgent medical attention. Auckland, New Zealand Other side effects not listed above Toll Free number: 0800 736 363 may also occur in some patients.
Recommended publications
  • Enoxaparin Sodium Solution for Injection, Manufacturer's Standard
    PRODUCT MONOGRAPH INCLUDING PATIENT MEDICATION INFORMATION PrLOVENOX® Enoxaparin sodium solution for injection 30 mg in 0.3 mL solution (100 mg/mL), pre-filled syringes for subcutaneous or intravenous injection 40 mg in 0.4 mL solution (100 mg/mL), pre-filled syringes for subcutaneous or intravenous injection 60 mg in 0.6 mL solution (100 mg/mL), pre-filled syringes for subcutaneous or intravenous injection 80 mg in 0.8 mL solution (100 mg/mL), pre-filled syringes for subcutaneous or intravenous injection 100 mg in 1 mL solution (100 mg/mL), pre-filled syringes for subcutaneous or intravenous injection 300 mg in 3 mL solution (100 mg/mL), multidose vials for subcutaneous or intravenous injection PrLOVENOX® HP Enoxaparin sodium (High Potency) solution for injection 120 mg in 0.8 mL solution (150 mg/mL), pre-filled syringes for subcutaneous or intravenous injection 150 mg in 1 mL solution (150 mg/mL), pre-filled syringes for subcutaneous or intravenous injection Manufacturer’s standard Anticoagulant/Antithrombotic Agent ATC Code: B01AB05 Product Monograph – LOVENOX (enoxaparin) Page 1 of 113 sanofi-aventis Canada Inc. Date of Initial Approval: 2905 Place Louis-R.-Renaud February 9, 1993 Laval, Quebec H7V 0A3 Date of Revision September 7, 2021 Submission Control Number: 252514 s-a version 15.0 dated September 7, 2021 Product Monograph – LOVENOX (enoxaparin) Page 2 of 113 TABLE OF CONTENTS Sections or subsections that are not applicable at the time of authorization are not listed. TABLE OF CONTENTS ..............................................................................................................
    [Show full text]
  • Rtpa) for the Treatment of Hepatic Veno-Occlusive Disease (VOD
    Bone Marrow Transplantation, (1999) 23, 803–807 1999 Stockton Press All rights reserved 0268–3369/99 $12.00 http://www.stockton-press.co.uk/bmt Recombinant tissue plasminogen activator (rtPA) for the treatment of hepatic veno-occlusive disease (VOD) S Kulkarni1, M Rodriguez2, A Lafuente2, P Mateos2, J Mehta1, S Singhal1, R Saso3, D Tait4, JG Treleaven3 and RL Powles1 Departments of 1Medical Oncology, 3Haematology and 4Radiotherapy, Royal Marsden NHS Trust, Sutton, Surrey, UK; and 2Haematology Department, Hospital La Paz, Madrid, Spain Summary: clinical syndrome characterized by hyperbilirubinemia, hepatomegaly and fluid retention,2,3 and results from dam- Seventeen patients who developed hepatic veno-occlus- age to structures in zone 3 of the liver acinus.4 In patients ive disease (VOD) following hematopoietic stem cell who have undergone hematopoietic stem cell transplan- transplantation were treated with recombinant tissue tation, chemoradiotherapy-induced endothelial cell damage plasminogen activator (rtPA) with or without heparin. is likely to be responsible for the pathogenesis of vessel rtPA was started a median of 13 days post transplant obstruction.5 (range 4–35). All patients received rtPA at a dose of 10 Treatment of established VOD has primarily been sup- mg/day as a starting dose, and 12 patients also received portive and any specific measures have resulted in little heparin (1500 U bolus; then 100 U/kg/day as a continu- impact on outcome. Based on the available evidence for ous i.v. infusion). The median number of days of rtPA involvement of hemostatic mechanisms and cytokines in therapy was 2.5 (1–12). The median total serum biliru- the pathogenesis of VOD,6–8 anti-thrombotic and anti-cyto- bin level was 116 mmol/l (range 63–194) at the begin- kine agents have been assessed for their role in treatment.
    [Show full text]
  • Transition of Anticoagulants 2019
    Transition of Anticoagulants 2019 Van Hellerslia, PharmD, BCPS, CACP, Brand Generic Clinical Assistant Professor of Pharmacy Practice, Angiomax bivalirudin Temple University School of Pharmacy, Philadelphia, PA Arixtra fondaparinux Bevyxxa betrixaban Pallav Mehta, MD, Assistant Professor of Medicine, Coumadin warfarin Division of Hematology/Oncology, Eliquis apixaban MD Anderson Cancer Center at Cooper, Camden, NJ Fragmin dalteparin Lovenox enoxaparin Reviewer: Kelly Rudd, PharmD, BCPS, CACP, Pradaxa dabigatran Clinical Specialist, Anticoagulation, Bassett Medical Center, Savaysa edoxaban Cooperstown, NY Xarelto rivaroxaban From To Action Apixaban Argatroban/ Wait 12 hours after last dose of apixaban to initiate parenteral anticoagulant. In cases of Bivalirudin/ high bleeding risk, consider omitting initial bolus when transitioning to heparin infusion. Enoxaparin/ Dalteparin/ Fondaparinux/ Heparin Apixaban Warfarin When going from apixaban to warfarin, consider the use of parenteral anticoagulation as a bridge (eg, start heparin infusion or therapeutic enoxaparin AND warfarin 12 hours after last dose of apixaban and discontinue parenteral anticoagulant when INR is therapeutic). Apixaban affects INR so that initial INR measurements during the transition may not be useful for determining the appropriate dose of warfarin. Apixaban Betrixaban, Wait 12 hours from last dose of apixaban to initiate betrixaban, dabigatran, edoxaban, or Dabigatran, rivaroxaban. Edoxaban, or Rivaroxaban Argatroban Apixaban, Start apixaban, betrixaban, dabigatran,
    [Show full text]
  • (Dipotassium Salt) and Heparin on the Estimation of Packed Cell Volume
    J Clin Pathol: first published as 10.1136/jcp.19.2.196 on 1 March 1966. Downloaded from J. clin. Path. (1966), 19, 196 Effect of ethylene-diamine-tetra-acetic acid (dipotassium salt) and heparin on the estimation of packed cell volume C. A. PENNOCK AND K. W. JONES From the Department of Haematology, Gibson Laboratories, Radcliffe Infirmary, Oxford SYNOPSIS The effect of varying concentrations of ethylene-diamine-tetra-acetic acid (E.D.T.A.) (dipotassium salt) and heparin on the estimation of packed cell volume has been studied using a microhaematocrit method. Varying concentrations of E.D.T.A. can produce serious errors in estimation of packed cell volume (P.C.V.) and reliable results are only obtained within the range of 1 to 2 mg./ml. Heparin is a more suitable anticoagulant for this investigation as varying the con- centration has little effect. Storage with either anticoagulant at suitable concentrations for 24 hours at room temperature has little influence on the results. The estimation ofthe packed cell volume (P.C.V.) is bottles are often returned to this laboratory contain- regarded as a reliable investigation in the diagnosis ing less than the recommended amount of blood.copyright. of anaemia, and errors in the estimation of mean Ethylene-diamine-tetra-acetic acid is known to corpuscular haemoglobin concentration (M.C.H.C.) cause distortion and shrinkage of red cells and are thought to be due more often to errors in the to affect the estimation of P.C.V. by conventional estimation of haemoglobin than of the P.C.V.
    [Show full text]
  • Direct Versus Indirect Thrombin Inhibition in Percutaneous Coronary Intervention
    Direct Versus Indirect Thrombin Inhibition in Percutaneous Coronary Intervention Jonathan D. Marmur, MD, FACC Heparin rally occurring but slow thrombin inhibitor. The heparin:AT interaction produces conformational Heparin has been used to prevent intravascular changes in AT and accelerates its inhibition of throm- thrombosis and clotting on the surface of equipment bin, factor Xa, and factor IXa.10 used during percutaneous coronary interventions (PCI) Heparin catalysis of factor Xa inhibition does not since Andreas Gruentzig performed the first require bridging between factor Xa and AT. Since almost angioplasty.1 In fact, the development of coronary all the heparin chains are at least 18 units long, heparin angioplasty and of coronary artery bypass surgery would has equivalent inhibitory activity against thrombin and probably not have been possible without heparin. How- factor Xa.3 However, when thrombin is bound to fibrin, ever, with the availability of low molecular weight the heparin:AT complex is less able to access and inhibit heparin (LMWH) and the approval of bivalirudin, a thrombin.9 Furthermore, with respect to anti Xa activity, direct thrombin inhibitor for use during PCI, the ques- the heparin:AT complex is unable to inhibit factor Xa tion is more and more frequently asked whether heparin bound to the surface of activated platelets.11 should be replaced in PCI. The purpose of this paper is to critically review the evidence for the use of heparins Pharmacokinetics/pharmacodynamics. Heparin (indirect thrombin inhibitors) and direct thrombin must be given by injection since it is not absorbed when inhibitors during PCI. administered orally.10 Heparin is cleared via a biphasic process combining rapid saturable and slower first- Structure and mechanism of action of heparin.
    [Show full text]
  • Public Assessment Report
    PUBLIC ASSESSMENT REPORT Decentralised Procedure Fraxiparine 0.3 2,850 I.U. anti-Xa/ 0.3 ml; Fraxiparine 0.4 3,800 I.U. anti-Xa/ 0.4 ml; Fraxiparine 0.6 5,700 I.U. anti-Xa/ 0.6 ml; Fraxiparine 0.8 7,600 I.U. anti-Xa/ 0.8 ml Procedure Number: DE/H/4762/002-005/DC Fraxodi 19000 UL / ml; 0.6 ml Fraxodi 19000 UL / ml; 0.8 ml Fraxodi 19000 UL / ml; 1.0 ml Procedure Number: DE/H/4763/001-003/DC Fraxiparine Multi 9,500 anti-Xa IU/ 1.0 ml Fraxiparine Multi 9,500 anti-Xa IU/ 1.0 ml Procedure Number: DE/H/4770/001-002/DC Active Substance: Nadroparin-Calcium Dosage Form: Solution for injection Marketing Authorisation Holder in the RMS, Germany: Aspen Pharma Trading Limited Publication: 19.11.2018 TABLE OF CONTENTS I. RECOMMENDATION ................................................................................................................ 4 II. EXECUTIVE SUMMARY ....................................................................................................... 4 II.1 Problem statement ..................................................................................................................... 4 II.2 About the product ..................................................................................................................... 4 II.3 General comments on the submitted dossier .......................................................................... 4 II.4 General comments on compliance with GMP, GLP, GCP and agreed ethical principles. 5 III. SCIENTIFIC OVERVIEW AND DISCUSSION ..................................................................
    [Show full text]
  • Elective Surgery and Invasive Procedures in Patients Taking
    Volume 10, No. 5 January 2020 This Medicines Information Leaflet is produced locally to optimise the use of medicines by encouraging prescribing that is safe, clinically appropriate and cost-effective to the NHS. The management of patients who are receiving oral therapy if they are regarded as at high risk of anticoagulation with warfarin or a Direct Oral thrombosis (see table 1). The dose of dalteparin Anticoagulant (DOAC e.g. dabigatran, rivaroxaban, recommended for bridging is outlined in table 2. apixaban, edoxaban) who require surgery or are All patients who do not require bridging with full undergoing a procedure depends on the underlying treatment dose heparin peri-operatively should be thrombotic risk, the intended surgical intervention, risk assessed and given prophylactic dose LMWH as and the risk of bleeding associated with it. This MIL appropriate. covers the management of patients on warfarin or a DOAC undergoing elective procedures, grouped into Table 1: Consider bridging with full treatment dose three categories: major surgery (excluding vascular heparin in patients who stop warfarin if thrombotic surgery), minor surgery and endoscopy. risk is high Note: Patients within 3 months of acute venous Consider bridging with full treatment dose thromboembolism (VTE) are at high risk of recurrent heparin in: VTE if anticoagulation is stopped; it is estimated that VTE Patients with a VTE within previous 3 cessation of anticoagulation in the first month after months. an acute VTE is associated with a 40% one-month risk of recurrent VTE, and 10% for the subsequent Very high risk patients such as patients with two months. Therefore, wherever possible elective a previous VTE whilst on therapeutic surgery should be delayed until 3 months after an anticoagulation who now have a target INR acute VTE.
    [Show full text]
  • Cleveland Clinic Anticoagulation Management Program (C-Camp)
    CLEVELAND CLINIC ANTICOAGULATION MANAGEMENT PROGRAM (C-CAMP) 1 Table of Contents I. EXECUTIVE SUMMARY ......................................................................................................................................... 6 II. VENOUS THROMBOEMBOLISM RISK ASSESSMENT AND PROPHYLAXIS ............................................. 9 III. RECOMMENDED PROPHYLAXIS OPTIONS FOR THE PREVENTION OF VENOUS THROMBOEMBOLISM. ........................................................................................................................................ 10 IIIA. RECOMMENDED PROPHYLAXIS OPTIONS FOR THE PREVENTION OF VENOUS THROMBOEMBOLISM BASED ON RISK FACTOR ASSESSMENT ............................................................. 12 A) UNFRACTIONATED HEPARIN (UFH) ................................................................................................................... 14 B) LOW MOLECULAR WEIGHT HEPARIN (LMWH) ENOXAPARIN (LOVENOX®) .............................................. 14 C) FONDAPARINUX/ (ARIXTRA®) …………………………………………………………………………..……16 D) RIVAROXABAN (XARELTO®) .......................................................................................................................... 16 E) DESIRUDIN (IPRIVASK®)………………………………………………………………………………..…….17 F) WARFARIN/COUMADIN®) ............................................................................................................................... 16 G) ASPIRIN……………………………………………………………………………………………………..……18 H) INTERMITTENT PNEUMATIC COMPRESSION DEVICES .....................................................................................
    [Show full text]
  • Enoxaparin Updated November 2016
    Enoxaparin Updated November 2016 Enoxaparin is a low-molecular weight heparin (LMWH). Because of its lower protein-binding compared to unfractionated heparin (UFH), enoxaparin has more predictable pharmacokinetics and less need for therapeutic monitoring. Enoxaparin is frequently used as prophylaxis for deep venous thrombosis (DVT) in critically ill human patients. The ideal prophylactic regimen in critical care patients is still unclear and remains highly investigated. Individual patient factors (such as BMI and renal function) alter drug metabolism and, therefore, serum drug level monitoring to achieve a target anti-Xa factor blood level is ideal in higher risk patients. The availability of drug monitoring is poor and impractical in most veterinary settings. Thus recommendations for dose, route, and interval of administration in veterinary patients are extrapolated from those used in human patients. The ideal application, dosing guideline, and safety in veterinary patients remain unknown. Mechanism of Action: Heparin and LMW-heparins prevent clot formation by binding antithrombin. The heparin-antithrombin complex can then bind to and inactivate either thrombin (Factor II) or activated-Factor Xa. Low-molecular weight heparin will only bind and inactivate activated Factor Xa. Derivation and Metabolism: Derived from heparin to yield fragments one third the size of heparin. Mean LMWH size: 4500-5000 Da Metabolism: Hepatic metabolism via breakdown to less biologically active molecules. Approximately 10% of the Copyright: PolyMedix active drug is renally excreted. Maximum anti-Xa and anti-thrombin activity occurs 3-5 hours after administration. Steady state achieved after 24 hours of therapy Elimination half-life 4.5 hours (single dose) or 7 hours (repeated doses) Benefits of LMWHs: Lower binding properties than unfractionated heparin (UFH).
    [Show full text]
  • Transition of Anticoagulants 2016
    Transition of Anticoagulants 2016 Van Hellerslia, PharmD, BCPS, CACP, Clinical Assistant Professor of Pharmacy Practice, Brand Generic Temple University School of Pharmacy, Philadelphia, PA Angiomax bivalirudin Arixtra fondaparinux Pallav Mehta, MD, Assistant Professor of Medicine, Coumadin warfarin Division of Hematology/Oncology, Eliquis apixaban MD Anderson Cancer Center at Cooper Fragmin dalteparin Lovenox enoxaparin Reviewer: Kelly Rudd, PharmD, BCPS, CACP, Clinical Specialist, Anticoagulation, Pradaxa dabigatran Savaysa edoxaban Bassett Medical Center, Cooperstown, New York Xarelto rivaroxaban From To Action Apixaban Argatroban/ Wait 12 hours after last dose of apixaban to initiate parenteral anticoagulant. In cases of Bivalirudin/ high bleeding risk, consider omitting initial bolus when transitioning to heparin infusion. Enoxaparin/ Dalteparin/ Fondaparinux/ Heparin Apixaban Warfarin When going from apixaban to warfarin, consider the use of parenteral anticoagulation as a bridge (eg, start heparin infusion/enoxaparin and warfarin 12 hours after last dose of apixaban and discontinue parenteral anticoagulant when INR is therapeutic ≥2). Apixaban Dabigatran, Wait 12 hours from last dose of apixaban to initiate dabigatran, edoxaban, or rivaroxaban. Edoxaban, or Rivaroxaban Argatroban Apixaban, Start apixaban, dabigatran, edoxaban, or rivaroxaban within 2 hours of stopping argatroban. Dabigatran, Edoxaban, or Rivaroxaban Argatroban Enoxaparin/ If no hepatic insufficiency, start parenteral anticoagulant within 2 hours of stopping Dalteparin/ argatroban. If there is hepatic insufficiency, start parenteral anticoagulant after 2-4 hours of Fondaparinux/ stopping argatroban. Heparin *The use of enoxaparin/dalteparin/heparin assumes the patient does not have heparin allergy or heparin-induced thrombocytopenia. Argatroban Warfarin Argatroban must be continued when warfarin is initiated and co-administration should continue for at least 5 days. Argatroban elevates the INR.
    [Show full text]
  • The Pharmacodynamic Effect of ELIQUIS Can Be Expected to Persist for at Least 24 Hours After the Last Dose, Ie, for About Two Drug Half Lives
    Dosing Guide for All ELIQUIS Indications Find out more at hcp.eliquis.com Please see full Prescribing Information including Boxed WARNINGS and Medication Guide or visit ELIQUIS.com. ELIQUIS® (apixaban) INDICATIONS Approved for 6 indications to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) for the treatment of deep vein thrombosis (DVT) for the treatment of pulmonary embolism (PE) to reduce the risk of recurrent DVT and PE following initial therapy for the prophylaxis of DVT, which may lead to PE, in patients who have undergone hip replacement surgery for the prophylaxis of DVT, which may lead to PE, in patients who have undergone knee replacement surgery SELECTED IMPORTANT SAFETY INFORMATION WARNING: (A) PREMATURE DISCONTINUATION OF ELIQUIS INCREASES THE RISK OF THROMBOTIC EVENTS, (B) SPINAL/EPIDURAL HEMATOMA (A) Premature discontinuation of any oral anticoagulant, including ELIQUIS, increases the risk of thrombotic events. If anticoagulation with ELIQUIS is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant. (B) Epidural or spinal hematomas may occur in patients treated with ELIQUIS who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include: • use of indwelling epidural catheters • concomitant use of other drugs that affect hemostasis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants • a history of traumatic or repeated epidural or spinal punctures • a history of spinal deformity or spinal surgery • optimal timing between the administration of ELIQUIS and neuraxial procedures is not known Monitor patients frequently for signs and symptoms of neurological impairment.
    [Show full text]
  • Expert John L
    Ask the expert John L. Petrini, Antithrombotic agents during endoscopy MD, FASGE 1. Q: Do you routinely discontinue warfarin in patients with chronic atrial fibrillation without valvular heart disease or prior embolic events prior to: Ask the expert features A. Routine screening colonoscopy? questions submitted by B. Colonoscopy for a positive fecal occult blood test? C. Endoscopy for iron deficiency anemia? members, with answers D. Colonoscopy for prior adenomatous polyp(s)? provided by ASGE A: The decision to stop anticoagulation depends on the perceived risk of a thromboembolic event. If the risk is physician experts. ASGE’s high (e.g., elderly patient, chronic atrial fibrillation, valvular heart disease or prior thromboembolic events), the morbidity and mortality associated with interrupting or modifying anticoagulation is substantial, which, in Publications Committee my opinion, is unacceptable. Therefore, in those patients, I do not recommend stopping anticoagulation before identifies authors and routine screening colonoscopy (A). topics for the column. In fact, I do not recommend stopping anticoagulation for colonoscopy in patients with any of the above In this issue, ASGE indications. The decision to modify or stop anticoagulation for patients who have positive fecal occult blood 2008-09 Past President, tests or iron deficiency anemia is left to the cardiologist or primary care physician. For patients undergoing surveillance colonoscopy for prior adenomatous polyps, I do not interrupt anticoagulation for high-risk patients John L. Petrini, MD, and advise them of the slightly increased risk of bleeding associated with removing polyps while on FASGE, responds an anticoagulant. to questions on antithrombotic agents 2. Q: What are your thoughts on starting aspirin and/or clopidogrel (Plavix) after a polypectomy for a 1 cm or larger pedunculated polyp? during endoscopy.
    [Show full text]