Drotrecogin alfa is a recombinant form of activated protein C that was initially approved by the FDA in 2001 for reduction of mortality in adults with sepsis associated with acute organ dysfunction and high mortality. The drug was voluntarily withdrawn from the market in 2011 after a follow-up study showed no survival benefit in sepsis.
Aminocaproic acid Generic, Amicar
Antihemophilic factor Alphanate, Bioclate, Helixate, Hemofil [factor VIII, AHF] M, Koate-HP, Kogenate, Monoclate, Recombinate, others
Anti-inhibitor coagulant complex Autoplex T, Feiba VH Immuno
Antithrombin III Thrombate III, ATryn
Bivalirudin Generic, Angiomax
Cilostazol Generic, Pletal
Clopidogrel Generic, Plavix
Dipyridamole Generic, Persantine
Enoxaparin (low-molecular-Generic, Lovenox weight heparin)
January C et al: 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014;64:e1.
Li A, Lopes RD, Garcia DA: Use of direct oral anticoagulants in special populations. Hematol Oncol Clin North Am 2016;30:1053.
Samuelson BT, Cuker A: Measurement and reversal of the direct oral anticoagulants. Blood Rev 2016;31:77.
Dahlback B: Advances in understanding pathogenic mechanisms of thrombophilic disorders. Blood 2008;112:19.
Factor IX complex, human AlphaNine SD, Bebulin VH, BeneFix, Konyne 80, Mononine, Profilnine SD, Proplex T, Proplex SX-T
Fondaparinux Generic, Arixtra
Heparin sodium Generic, Liquaemin
Ticlopidine Generic, Ticlid
Tranexamic acid Generic, Cyklokapron, Lysteda
Urokinase Abbokinase, Kinlytic
Vitamin K Generic, various
Warfarin Generic, Coumadin
Mannucci PM, Levi M: Prevention and treatment of major blood loss. N Engl J Med 2007;356:2301.
Furie B: Do pharmacogenetics have a role in the dosing of vitamin K antagonists? N Engl J Med 2013;369:2345.
Kearon C et al: Antithrombotic therapy for VTE disease: Chest guideline and expert panel report. Chest 2016;149:315.
This patient has pulmonary embolism secondary to a deep venous thrombosis (DVT). Options for treating this patient include unfractionated heparin or low-molecular-weight heparin followed by warfarin, with INR goal of 2–3; parenteral anticoagulation for 5–7 days followed by edoxaban; or rivaroxaban, apixaban, or dabigatran alone without monitoring. As this situation can be considered a provoked event given the history of oral contraceptive use, the recommended duration of therapy would be 3–6 months depending on individual risk factors and preferences. The patient should be counseled to use an alternative form of contraception.
Mary J. Malloy, MD, & John P. Kane, MD, PhD