Table 4.
Guidelines for interrupting drotrecogin alfa (activated) infusion for an invasive procedure
| Procedurea | Pre-procedure: stop DrotAA | Post-procedure: reconsider DrotAAb |
| Minor procedure | ||
| Arterial line insertion | 2 hours before procedure | Immediately afterward |
| Venous femoral line insertion | 2 hours before procedure | Immediately afterward |
| Re-intubation (tube change) | 2 hours before procedure | Immediately afterward |
| More invasive procedure | ||
| Central venous catheter insertion via compressible site (e.g. via femoral vein) | 2 hours before procedure | Immediately afterward |
| Central venous catheter insertion via noncompressible site (e.g. via subclavian or jugular vein) | 2 hours before procedure | 2 hours afterward |
| Chest tube insertion or thoracic drainage | 2 hours before procedure | 2 hours afterward |
| Gastroscopy (possible biopsy) | 2 hours before procedure | 2 hours afterward |
| Lumbar puncture | 2 hours before procedure | 2 hours afterward |
| Nephrostomy | 2 hours before procedure | 2 hours afterward |
| Paracentesis | 2 hours before procedure | 2 hours afterward |
| Percutaneous drainage | 2 hours before procedure | 2 hours afterward |
| Sinus puncture | 2 hours before procedure | 2 hours afterward |
| Tracheostomy | 2 hours before procedure | 1 hour afterward |
| Wound debridement (decubitus ulcer, infected wound, packing changes in open abdomen, etc.) | 2 hours before procedure | 2 hours afterward |
| Major procedure | ||
| Major surgical procedurec | 2 hours before procedure | Wait 12 hours |
| Epidural catheter | 2 hours before procedure; withhold drotrecogin alfa (activated) while catheter present | Wait at least 12 hours after catheter removal before initiating drotrecogin alfa (activated) infusion |
| Other | ||
| CPR | When beginning CPR | Evaluate neurologic status before resuming drotrecogin alfa (activated). If chest trauma occurred, wait 12 hours |
aThese guidelines assume that the procedures listed (with the exception of initiation of cardiopulmonary resuscitation [CPR]) are non-emergency. For emergency procedures, the drotrecogin alfa (activated; DrotAA) infusion should be discontinued as soon as possible. The subsequent decision regarding whether and when to reinitiate the infusion depends on the type of procedure and the patient's clinical condition. bIf no signs and symptoms of bleeding are present and the investigator/clinician feels that there is minimal risk for bleeding complications. cA significant surgical procedure that requires the use of an operating room, anesthesia, and so on. DrotAA, drotrecogin alfa (activated). Modified with permission from Laterre and Wittebole [23].