Table 4.
Drug | Bolus | Dosage | Dosage in renal impairment | Dosage in hepatic impairment | Availability in Australia |
Lepirudin | Only if life or limb threatening thrombosis. 0.4 mg/kg iv | 0.1-0.15 mg/kg per hour | Cr. Cl. 45-60: 50% of original infusion rate. Cr. Cl. 30-44: 30% of original infusion rate. Cr. Cl. 15-29: 15% of original infusion rate according to body weight. Avoid if Cr. Cl. Lower or use 0.005 mg/kg per hour if on haemofiltration | No change | Discontinued |
Desirudin | None | 15-30 mg sc bd. Limited data | Not recommended given paucity of data | No change | Not available |
Danaparoid | IV according to body weight. < 60 kg: 1500 U; 60-75 kg: 2250 U; 75-90 kg: 3000 U; > 90 kg: 3750 U | 400 U/h IV × 4 h followed by 300 U/h IV × 4 h followed by 200 U/h iv | Reduce dose by 30% and monitor antiXa activity | No change | Available |
Bivalirudin | None | 0.15-0.2 mg/kg per minute | Cr. Cl 10-29: 0.06 mg/kg per minute; Cr. Cl < 10: 0.015 mg/kg per minute iv | No change | Available |
Fondaparinux | None | < 50 kg: 5 mg sc; 50-100 kg: 7.5 mg sc; > 100 kg: 10 mg sc | Cr. Cl 30-50: monitor closely. Cr. Cl < 30: Contraindicated | No change | Available |
Argatroban | None | 2 mcg/kg per minute iv | No change | 0.5 mcg/kg per minute | Not available |
Cr. Cl.: Creatinine clearance in mL/min; sc: Subcutaneous; iv: Intravenous.