0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

CONTRAINDICATIONS

■ Hypersensitivity, active bleeding

MONITORING

■ Factor Xa levels (monitor in patients with CrCl <30)

COMPLICATIONS

■ Major bleeding

REVERSAL

■ Protamine 1 mg IV for every 1 mg of enoxaparin

Direct Thrombin Inhibitors

Inhibit circulating and clot bound thrombin; include lepirudin, argatroban;

indicated in patients with HIT

Aspirin

Aspirin irreversibly inhibits cyclooxygenase, which prevents synthesis of throm-

boxane needed for platelet aggregation.

CONTRAINDICATION

■ Hypersensitivity reaction, severe hepatic disease, bleeding disorder, major

GI bleed

DOSE

■ ASA 81–162 mg PO daily

COMPLICATIONS

■ Bleeding, allergic reactions

TREATMENT OF BLEEDING

■ Transfuse platelets to keep platelets >50,000/μL.

Thienopyridines

Irreversibly inhibit platelet aggregation via adenosine diphosphate receptor

antagonism; includes clopidogrel, ticlopidine

CONTRAINDICATION

■ Active severe bleeding, hypersensitivity

COMPLICATIONS

■ GI bleeding, hypersensitivity, TTP (more common with ticlopidine), neu-

tropenia (more common with ticlopidine)

TREATMENT

■ Bleeding

■ Transfuse platelets to keep platelets >50,000/μL.

The dosing of low-molecular-

weight heparin must be

reduced in patients with

severe renal impairment.