Table 6.

Clinical uses of DTIs

Drugs	Indications	Dosing, timing, duration	Monitoring	Precautions
Bivalirudin (Angiomax™)	PCI (with or without glycoprotein IIB/IIIA inhibitor)	0.75 mg/kg IV bolus dose, followed by an infusion of 1.75 mg/kg/h for the duration of the procedure	CBC aPTT ACT PT/INR (false elevation while on infusion) Blood pressure Heart rate ECG Renal function (bivalirudin) Hepatic function (argatroban)	Indwelling epidural catheter Recent major, spinal or ophthalmologic surgery History of recent major bleed (gastrointestinal, intracranial, etc.) Congenital or acquired bleeding disorders Recent cerebrovascular accident Hepatic impairment (argatroban) Renal dysfunction (bivalirudin)
		CrCl less than 30 mL/min, a reduction of initial infusion rate to 1 mg/kg/h should be considered; no bolus dose reduction is necessary
	Treatment of ACSa	Initial IV bolus dose of 0.1 mg/kg, followed by 0.25 mg/kg/h.
	Treatment and prophylaxis of HITTa	0.15–0.2 mg/kg/h, titration to aPTT 1.5–2.5 times control
Argatroban	Treatment and prophylaxis of HITT	0.5–1.2 μg/kg/min continuous IV infusion to start titration to goal aPTT of 1.5–3 times baseline
		Begin VKA therapy, measure INR daily. Stop argatroban when INR >4. Repeat INR in 4–6 h, if INR is below desired range then resume argatroban infusion
	PCI	Bolus: 350 μg/kg
		Initial infusion: 25 μg/kg/min maintain ACT greater than 300 seconds
Desirudin	Prophylaxis of DVT in patients undergoing elective hip replacement surgery	15 mg SC every 12 h given 5–15 min prior to surgery but before induction of regional block anesthesia (if used)

PCI percutaneous coronary intervention, IV intravenous, CrCl creatinine clearance using the Cockroft–Gault Equation, CBC complete blood count, aPTT activated partial thromboplastin time, ACT activated clotting time, PT prothrombin time, INR international normalized ratio, ECG echocardiogram, HITT heparin-induced thrombocytopenia and thrombosis, VKA vitamin K antagonist, ACS acute coronary syndrome

^aIndicates off label use of medication