Nursebob’s MICU/CCU Survival Guide

Critical Care Medication

Anticoagulants.

Lipirudin (Refludan)

04.12.05

1. Description of Lepirudin

A. For IV infusion only

B. Thrombin inhibitor

C. Genetically engineered.

D. Used for patients with heparin induced thrombocytopenia (HIT).

a. Deccrease in circulating platelets.

b. High risk of venous and arterial thrombosis.

c. An immune response to heparin.

2. Preparation of Lepirudin.

A. Supplied – powder in 50-mg vials.

B. Use two vials of lepirudin

C. Inject 1 ml of sterile water for injection or 0.9% sodium chloride solution into each vial.

C. Depending on the order and dosage

a. Inject the contents of both vials into a bag of 500 ml of 0.9% NaCl or D5W, this will yield 0.2 mg/ml.

b. Inject the contents of both vials into a bag of 250 ml of 0.9% NaCl or D5W, this will yield 0.4 mg/ml

3. Dosing of Lepirudin

A. Loading dose by slow iv bolus over 15-30 seconds.

a. The maximum initial bolus is 44 mg

b. Patients up to 242.5 pounds (110 kg), the initial dosage is 0.4 mg/kg administered as a bolus

B. Continous IV infusion

a. Maximum initial infusion dosage is 16.5 mg/kg/hour

b. Patients up to 242.5 pounds (110 kg), 0.15 mg/kg/hour as a continuous I.V infusion, for 2 to 10 days

4. Lepirudin is metabolized by the kidneys

A. Reduce the dosage in patients with impaired renal function.

5. Adverse reactions

A. Bleeding is most common.

a. Puncture sites

b. Wounds

c. GI tract, nose

d. Intracranial bleeding

e. Monitor the patient for anemia or a drop in hemoglobin level.

f. Impaired kidney function

6. Monitor.

A. Monitor your patient's PTT ratio and aim for a range from 1.5 to 2.5.