antithrombin alfa (Rx)

Brand and Other Names:Antithrombin Recombinant, Atryn
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 1750 International Unit/vial
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Therapeutic Goal

Prophylaxis of thrombosis during surgical or obstetrical procedures

Increase & maintain antithrombin activity between 80-120% (0.8-1.2 International Unit/mL) during treatment

Loading dose should target 100% AT activity level based on weight & pretreatment AT activity level

Surgical Patients

Load = [(100 - baseline AT activity level in %)/2.3] x kg Body Weight = units of antithrombin required IV; infuse over 15 minutes

Maintenance (International Unit/hr) = [(100 - baseline AT activity level in %)/10.2] x kg BW = units of antithrombin required/hr IV

Pregnant

Load = [(100 - baseline AT activity level in %)/1.3] x kg Body Weight = units of antithrombin required IV infuse over 15 minutes

Maintenance (International Unit/hr) = [(100 - baseline AT activity level in %)/5.4] x kg BW = units of antithrombin required/hr IV

Dose Adjustments

Draw AT activity levels 2 hours after start of loading dose, AFTER start of maintenance dose infusion

IF AT activity level 80%-120% (0.8-1.2 International Unit/mL): NO dose adjustment

If AT activity level <80%: Increase maintenance infusion rate by 30%; recheck AT level 2 hr after adjustment

If AT activity level >120%: Decrease infusion rate by 30%

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Interactions

Interaction Checker

and antithrombin alfa

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
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            Adverse Effects

            1-10%

            Application site pruritus (≥5%)

            Chest pain; non cardiac (≤2%)

            Dizziness (2%)

            Hemorrhage (≥5%)

            Hematoma (<2%)

            Hepatic enzyme changes ( ≤ 2%)

            Post procedural hemorrhage (≥5%)

            Hematuria (≥2%)

            <1%

            Chest tightness

            Nausea

            Foul taste

            Cramps

            Chills

            Film over eyes

            Hives

            Lightheadedness

            Bowel fullness

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            Warnings

            Contraindications

            Hypersensitivity to goat protein or goat milk components

            Cautions

            May increase risk of bleeding

            Not for treatment of thromboembolic activity in hereditary antithrombin deficient patients

            Monitor patients for possible immunological reactions, including antibody status

            Provide appropriate clinical testing when antithrombin is used with heparin or other anticoagulants

            Half-life and clearance differs significantly (7-9 times) between plasma derived and recombinant derived product

            Perform anticoagulation studies (APTT, anti-Factor Xa) at close intervals when starting antithrombin treatment

            Measure antithrombin levels daily, in order to adjust individual dose

            Risk of diminishing antithrombin levels with prolonged treatment with non-fractionated heparin

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Enters breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Serine protease inhibitor; important natural inhibitor of blood coagulation; inactivation of thrombin, plasmin, and other active serine proteases of coagulation including factors IXa, Xa, XIa, and XIIa.

            Pharmacokinetics

            Half-life: 12-18 hr; childbirth hemorrhage, surgery, and/or concomitant heparin may shorten half-life

            Vd: 14.3 L (pregnant women); 7.7L (nonpregnant patients)

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            Administration

            IV Preparation

            Bring vial to room temp prior to reconstitution; keep no longer than 3 hr

            Reconstitute preparation with 10 mL SWI injected along side wall

            Gently swirl, don't shake

            Inspect visually for particulate matter & discoloration prior to administration

            • do NOT use if deposits or cloudiness present

            Draw reconstituted product into sterile disposable syringe

            IV Administration

            Administer by IV infusion using sterile syringe or infusion bag w/ 0.22 micron pore inline filter

            May add NS to dilute for admininistration purposes

            Use infusion soln within 8 hr of preparation

            Compatible w/ PVC infusion lines with inline filters

            Initial infusion over 15 min, then continuous infusion

            Storage

            Store in refrigerator (2-8°C)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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