Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 1750 International Unit/vial
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%
No experience
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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
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
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.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)
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
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