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Generic Brand Indication Usual Adult Dosing
Anticoagulant Proteins
protein C concentrate [human] Ceprotin Prophylaxis and treatment of venous thrombosis and purpura fulminans in severe congenital protein C deficiency Individualize. ≥10kg: max infusion rate 2mL/min.
Acute episodes/short term prophylaxis: initially 100−120 IU/kg, then 60−80 IU/kg every 6hrs for 3 doses (titrate to maintain target peak protein C activity of 100%); maintenance: 45−60 IU/kg every 6 or 12hrs (After resolution of acute episode, continue patient on same dose to maintain trough protein C level above 25% for duration of therapy); continue until desired anticoagulation achieved.
Long-term prophylaxis: 45−60 IU/kg every 12hrs (maintain trough protein C level above 25%).
antithrombin [recombi
ATryn Prevention of peri-operative and peri-partum thromboembolic events in hereditary antithrombin deficient patients Individualize. Administer loading dose as 15min IV infusion, followed by continuous IV infusion of maintenance dose. Monitor antithrombin activity once or twice daily and adjust to maintain antithrombin activity between 80−120%. See full labeling.
antithrombin III [human] Thrombate
Treatment of hereditary antithrombin III deficiency (AT‑III) in surgical or obstetrical procedures or patients who suffer from thromboembolism Individualize. Dose (units required) = [desired (% of normal) − baseline (% of normal) AT‑III level] × weight (kg)/1.4.
Give by IV infusion over 10−20min. Loading dose: increase AT‑III to 120% of normal. Subsequent dose should be based on AT‑III levels obtained 20min post-infusion, every 12hrs, and before the next dose. Maintain AT‑III levels at 80−120% of normal for 2−8 days. See full labeling.
warfarin Coumadin Prophylaxis and treatment of thromboembolic complications of atrial fibrillation and/or cardiac valve replacement Individualize. Initially 2–5mg daily. Usual maintenance: 2–10mg daily; adjust based on INR. CYP2C9 or VKORC1 enzyme variations, elderly, debilitated, Asians: use lower initial dose.
Reduce risk of death, recurrent MI, and thromboembolic events post‑MI
Direct Thrombin Inhibitors
argatroban Prophylaxis and treatment of thrombosis in HIT/HITTS Before administering, discontinue heparin and obtain a baseline aPTT. Initially 2mcg/kg/min continuous IV infusion; check aPTT 2hrs after starting; titrate to 1.5−3x baseline aPTT (max 100sec); max 10mcg/kg/min.
PCI with or at risk of HIT/HITTS Initially 25mcg/kg/min by IV infusion, and a 350mcg/kg bolus by large bore IV line over 3−5min; ACT should be checked 5−10min after bolus, and titrate to therapeutic ACT of 300−450sec.
bivalirudin Angiomax Unstable angina undergoing PTCA 0.75mg/kg IV bolus (may give additional 0.3mg/kg bolus after 5mins, if needed in those without HIT/HITTS), followed by 1.75mg/kg/hr for duration of procedure. May continue infusion up to 4hrs post‑op; after 4hrs, may give additional infusion of 0.2mg/kg/hr up to 20hrs, if needed. Give with aspirin 300−325mg daily. Renal impairment: CrCl <30mL/min: reduce infusion rate to 1mg/kg/hr; hemodialysis: 0.25mg/kg/hr.
PCI with provisional GP IIb/IIIa blocker use
PCI with or at risk of HIT/HITTS
dabigatran Pradaxa Reduce risk of stroke and systemic embolism in non-valvular atrial fibrillation CrCl>30mL/min: 150mg twice daily. Renal impairment (CrCl 15−30mL/min): 75mg twice daily; CrCl<15mL/min or on dialysis: not recommended. Moderate renal impairment (CrCl 30–50mL/min) with concomitant dronedarone or systemic ketoconazole: consider reducing dose to 75mg twice daily. CrCl <30mL/min with concomitant P-gp inhibitors: avoid.
lepirudin Refludan HIT and associated thromboembolic disease ≤110kg: Initial 0.4mg/kg slow IV bolus inj for 15−20sec, then 0.15mg/kg/hr as continuous infusion for 2−10 days or longer if needed. >110kg: max initial bolus dose 44mg; max initial infusion dose 16.5mg/hr.
Factor Xa Inhibitors
apixaban Eliquis Reduce risk of stroke and systemic embolism in non-valvular atrial fibrillation 5mg twice daily; 2.5mg twice daily if patient has any 2 of the following: age ≥80yrs, ≤60kg, or creatinine ≥1.5mg/dL.
rivaroxaban Xarelto Reduce risk of stroke and systemic embolism in non-valvular atrial fibrillation CrCl >50mL/min: 20mg once daily with PM meal; CrCl 15–50mL/min: 15mg once daily with PM meal.
Low Molecular Weight Heparins
dalteparin Fragmin Prophylaxis of ischemic complications of unstable angina and non-Q‑wave MI 120 IU/kg SC (max 10,000 IU) every 12hrs until stabilized with aspirin 75−165mg once daily for 5−8 days.
enoxaparin Lovenox Prophylaxis of ischemic complications of unstable angina and non-Q‑wave MI 1mg/kg SC every 12hrs for 2−8 days; with aspirin 100−325mg once daily.
Acute STEMI (patients <75 yrs); with or without subsequent PCI 30mg IV bolus + 1mg/kg SC dose then 1mg/kg SC every 12hrs at least 8 days (max 100mg for first 2 doses only); with aspirin 75−325mg once daily. If last dose given <8hrs before balloon inflation, no dose needed; >8hrs before balloon inflation: give 0.3mg/kg IV bolus.
Acute STEMI (patients ≥75 yrs) 0.75mg/kg SC every 12hrs (no bolus) at least 8 days (max 75mg for first 2 doses only); with aspirin 75−325mg once daily.
Generic Brand Indication Usual Adult Dosing
dipyridamole Persantine Adjunct prophylactic therapy to coumarin anticoagulants after cardiac valve replacement 75−100mg four times a day as an adjunct to usual warfarin therapy.
Antiplatelet +
Nonsteroidal Antiinflammatory Drugs (NSAID)
dipyridamole + aspirin Aggrenox Reduce risk of stroke after transient ischemia of the brain or complete ischemic stroke due to thrombosis 1 cap twice daily (AM and PM). Alternative if intolerable headaches: switch to 1 cap at bedtime and low-dose aspirin in AM; return to usual regimen within 1wk.
Glycoprotein IIb/IIIa (GP IIb/IIIa) Blockers
abciximab Reopro Adjunct to PCI for prevention of cardiac ischemic complications 0.25mg/kg IV bolus over 10−60min before start of PCI, then a continuous IV infusion of 0.125mcg/kg/min (max 10mcg/min) for 12hrs. Use with heparin and aspirin.
Unstable angina not responding to conventional therapy, undergoing PCI within 24hrs 0.25mg/kg IV bolus, then 10mcg/min IV infusion over 18−24hr concluding 1hr after PCI.
eptifibatide Integrilin ACS: managed medically and those undergoing PCI 180mcg/kg IV bolus, then continuous IV infusion of 2mcg/kg/min until discharge or CABG surgery, up to 72hrs. If PCI planned, continue infusion until discharge, or for up to 18−24hrs after procedure, whichever comes first, allowing up to 96hrs of therapy. Concomitant use with aspirin and heparin.
PCI, including those undergoing intracoronary stenting 180mcg/kg IV bolus immediately before PCI followed by 2mcg/kg/min continuous infusion; repeat 180mcg/kg IV bolus 10min after the 1st bolus; continue infusion until discharge, or for up to 18−24hrs, whichever comes first, minimum 12hr-infusion recommended. Concomitant use with aspirin and heparin
tirofiban Aggrastat Reduce thrombotic CV events in patients with non-ST elevation ACS 25mcg/kg IV within 5mins, then 0.15mcg/kg/min for up to 18hrs. Renal impairment (CrCl<60mL/min): 25mcg/kg IV within 5mins, then 0.075mcg/kg/min for up to 18hrs.
Platelet Reducing Agents
anagrelide Agrylin Treatment of thrombocythemia secondary to myeloproliferative disorders Initially 0.5mg four times daily or 1mg twice daily for ≥1wk. May increase dose by 0.5mg/day weekly to maintain normal platelet count; max 10mg/day or 2.5mg/dose.
Protease-Activated Receptor-1 (PAR-1) Antagonist
vorapaxar Zontivity Reduce thrombotic CV events in patients with history of MI or with peripheral arterial disease 2.08mg once daily. Take with aspirin and/or clopidogrel based on indications.
P2Y12 Platelet Inhibitor (cyclopentyltriazolopyrimidine)
ticagrelor Brilinta Reduce thrombotic CV events in patients with ACS or history of MI Loading dose: 180mg once. Maintenance: 90mg twice daily for 1yr, then 60mg twice daily thereafter. Take with aspirin dose of 75–100mg daily.
P2Y12 Platelet Inhibitor (thienopyridines)
clopidogrel Plavix Acute coronary syndrome (ACS) Initially one 300mg loading dose, then 75mg once daily; take with aspirin. CYP2C19 poor metabolizers: consider alternatives.
Recent MI, stroke or established peripheral arterial disease 75mg once daily.
CYP2C19 poor metabolizers: consider alternatives.
prasugrel Effient Reduce thrombotic CV events in patients with ACS, managed with PCI Loading dose: 60mg once. Maintenance: 10mg once daily. <60kg: consider 5mg once daily. Take with aspirin (75mg−325mg daily)

Reduce risk of thrombotic stroke in aspirin intolerant patients who’ve had a completed thrombotic stroke 250mg twice daily with food.
Reduce incidence of subacute stent thrombosis for successful coronary artery stenting 250mg twice daily with food together with antiplatelet doses of aspirin for up to 30 days of therapy following successful stent implantation.
Tissue Plasminogen Activators (tPA)
alteplase Activase Management of acute MI Max 100mg/dose. Accelerated infusion: ≤67kg: 15mg IV bolus, then 0.75mg/kg (max 50mg) infused over 30min, then 0.5mg/kg (max 35mg) over 60min. >67kg: 15mg IV bolus, then 50mg infused over 30min, then 35mg infused over 60min; 3‑hour infusion: (≥65kg): 60mg infused in the 1st hour (of which 6−10mg is given as bolus), then 20mg/hr for 2hrs; (<65kg): 1.25mg/kg over 3hrs (of which 0.075mg/kg as bolus, 0.675mg/kg for the rest of the 1st hour, then 0.25mg/kg/hr for 2hrs). May use concomitantly with heparin.
Management of acute ischemic stroke Initiate within 3hrs of symptom onset. 0.9mg/kg (max 90mg) infused over 60min with 10% of total dose given as initial IV bolus over 1min.
reteplase Retavase Management of acute MI 10 IU as IV bolus over 2min; repeat dose 30min after initiation of 1st bolus.
tenecteplase TNKase Reduce mortality associated with AMI Give as single IV bolus over 5sec. <60kg: 30mg; ≥60kg−<70kg: 35mg; ≥70kg−<80kg: 40mg; ≥80kg−<90kg: 45mg; ≥90kg: 50kg. Max: 50mg.

Key: ACS = acute coronary syndrome; ACT = activated clotting time; AMI = acute myocardial infarction; CV = cardiovascular; HIT = heparin-induced thrombocytopenia; HITTS = HIT and thrombosis syndrome; MI = myocardial infarction; PCI = percutaneous coronary intervention; PM = evening; PTCA = percutaneous transluminal coronary angioplasty; SC = subcutaneous

Not an inclusive list of medications, official indications, and/or dosing details. Please see drug monograph at and/or contact company for full drug labeling.

(Rev. 10/2017)

This article originally appeared on MPR