Table 4. Drugs
Class/Agent (Brand)
Oral Anticoagulants VKAs
Warfarin (Coumadin® Jantoven®
)
Dabigatran (Pradaxa®
) , PO
Direct thrombin inhibitor PO
Factor Xa Inhibitor )
Rivaroxaban (Xarelto®
Adjust to INR
CrCl > 30 mL/min: 150 mg bid CrCl 15-30 mL/min: 75 mg bid
PO with the evening meal
Injectables Anticoagulants Heparin (UFH) IV
LMWH
Enoxaparin (Lovenox®
)
Dalteparin (Fragmin®
Subcut, (IV)
Preventive: 30 mg
q12h or 40 mg daily Rx: 1 mg/kg q12h or 1.5 mg/kg daily
)
Subcut Preventive: 2500-5000 units daily Rx: 200 units/kg daily
Tinzaparin (Innohep®
)
Factor Xa Inhibitor )
Fondaparinux (Arixtra®
Alteplase (Activase®
) Subcut 175 units/kg daily
FDA-approved for prophylaxis and treatment of DVT, prophylaxis of ischemic complications of unstable angina and non–Q-wave MI, and treatment of acute STEMI
FDA-approved for prophylaxis of DVT, prophylaxis of ischemic complications of unstable angina and non–Q-wave MI, and extended treatment of symptomatic venous thromboembolism in patients with cancer
FDA-approved for the treatment of acute symptomatic DVT with or without pulmonary embolism when administered in conjunction with warfarin sodium
Subcut 2.5-10 mg daily
Recombinant tissue plasminogen activator (r-tPA) IV
100 mg given over 2 hours
FDA-approved for prophylaxis of DVT and treatment of DVT and PE.
Indicated for treatment of acute massive pulmonary embolism
CrCl > 50 mL/min: 20 mg once daily CrCl 15-50 mL/min: 15 mg once daily
FDA-approved to reduce the risk of stroke and systemic embolism in patients with nonvalvular AF
FDA-approved to reduce the risk of stroke and systemic embolism in patients with nonvalvular AF (approved after submission of the guidelines)
Adjust to APTT Route Dose Comments
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