In this article, we will discuss Anticoagulants (Dosage). So, let’s get started.
Acenocoumarol 2 months-1 year: 0.2 mg/day, 1-5 years: 0.09 mg/day, 6-10 years: 0.07 mg/day, 11-18 years: 0.06 mg/day single dose oral, administered at the same time daily. Maintain INR 2-3 times of normal.
Adult dose: Initial loading dose 16-28 mg, followed by 8-10 mg on day 2 and then 2–10 mg/day as maintenance.
(Acitrom tabs 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg; sintrom tabs 1 mg, 2 mg, 4 mg).
Heparin for thrombosis treatment: 75 iu/kg IV bolus over 10 minutes followed by 28 iu/kg/hr for <1 year, 20 iu/kg/hr for >1 year as IV infusion. Adjust the dose to maintain anti-Xa activity 0.35–0.7 units/ml or aPTT between 60 and 85 seconds.
DVT prophylaxis: 5000 iu/dose SC q 8-12 hr until ambulatory.
Central line flush; patency: The amount is calculated on the basis of volume of the catheter or slightly higher, 10 units/ml every 6-8 hourly.
Peripheral arterial catheters in situ: Heparin infusion at 1 ml/hr (5 units/ml concentration).
Umbilical artery catheter (UAC): Heparin infusion at a concentration of 0.25-1 unit/ml; total heparin dose of 25–200 units/kg/day.
Note: Keep protamine sulfate ready as an antidote to treatvsevere life-threatening bleed due to over dose of heparin. Last dose of heparin <30 min: 1 mg protamine/100 iu heparin, 30-60 min: 0.5-0.75 mg protamine/100 iu heparin, 60-120 min:0.375-0.5 mg protamine/100 iu heparin, >120 min: 0.25-0375 mg protamine/100 iu heparin.
Low Molecular Weight Heparin (Enoxaparin) Recommended for prophylaxis and treatment of thrombo-embolic disorders specially for prevention of DVT following surgery. Administered with warfarin for inpatient treatment of DVT with or without pulmonary embolism and outpatient acute DVT without pulmonary embolism.
Subcutaneous: <2 months-Prophylaxis: 0.75 mg/kg/dose q 12 hourly; Treatment: 1.5 mg/kg/day q 12 hourly. 22 months to
518 years-Prophylaxis: 0.5 mg/kg/dose q 12 hourly; Treatment: 1 mg/kg/dose q 12 hourly.
Monitoring: Maintain anti-factor Xa 0.5-1.0 units/ml in a sample taken 4-6 hours after the subcutaneous injection.
Indication: DIC, purpura fulminans, and thromboembolism.
C/I: Bleeding disorder, and GI ulcer.
(Inj heparin 5 ml vial containing 1000 units and 5000 units per ml, 0.83 mg = 100 units).
Phenindione 0.5 to 4 mg/kg/day q 12 hr oral. Rarely used due to hypersensitivity reactions, warfarin is preferred.
Adult dose: 100 mg on 1st day, 50 mg on 2nd day and then 12.5-50 mg/day q 12 hr.
(Dindevan tab 50 mg).
Warfarin 0.05 to 0.34 mg/kg/day oral or parenteral. Adjust the dose to maintain desired prolongation of prothrombin time. The INR (international normalized ratio) should be maintained between 2 and 3.
Day 1: Initial loading dose 0.2 mg/kg/day once daily (if baseline INR 1-1.3).
Day 2 to 4: Additional loading doses depend upon patient’s INR. INR 1.1-1.3: Repeat the initial loading dose, INR 1.4-1.9: Dose is 50% of the initial loading dose, INR 3.1-3.5: Dose is 25% of the initial loading dose, INR >3.5: Hold the drug until INR <3.5, then restart at 50% of the previous dose.
Day >5: Maintenance dose depends upon patient’s INR. INR 1.1 to 1.4: Increase the dose by 20% of previous dose, INR 1.5-1.9: Increase the dose by 10% of previous dose, INR 2-3: No change, INR 3.1-3.5: Decrease the dose by 10% of previous dose, INR >3.5: Hold the drug until INR<3.5, then restart at 20% less than the previous dose.
Adult dose: 5 mg daily for 2 days and then 2.5 mg daily in a single dose.
(Uniwarfin, sofarin, warf, coumadin tabs 1 mg, 2 mg, 3 mg, 5 mg; inj coumadin 50 mg vial).