Monitoring involves measurement of anti-Xa activity done:
(1) after the initial drug bolus
(2) every 15 minutes during the procedure
(3) to confirm an unexpectedly low or high activity level
Danaparoid is used:
(1) in the pump priming solution
(2) as an IV bolus before starting the procedure
(3) as an infusion during the procedure
The pump priming solution is treated with 3,000 Units.
The initial bolus to the patient is given about 15-20 minutes before the anticipated start of the bypass. It is based on body weight:
initial IV bolus dose in Units =
= (100 * (body weight in kilograms))
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anti-Xa Activity After the Initial Bolus
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Action
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> 1.5 U/mL
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none (target level)
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1.2 - 1.5 U/mL
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administer a second IV bolus of 750 Units
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< 1.2 U/mL
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administer a second IV bolus of 1,500 Units
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During the procedure infusion danaparoid sodium at a rate of 200 Units per hour.
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anti-Xa Activity During the Procedure
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Action
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> 1.8 U/mL
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stop the infusion until the anti-Xa level is < 1.5 U/mL
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1.2 - 1.8 U/mL
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none (target level)
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1.0 - 1.19 U/mL
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increase the infusion rate to 300 Units per hour (increase infusion rate by 50%)
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< 1.0 U/mL
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give an IV bolus of 3,000 Units
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where:
• It may be necessary to increase the infusion rate for patients with anti-Xa activity < 1.0 U/mL, but it would seem smarter to see what the effect of the IV bolus is first.
The infusion of danaparoid is stopped 30 minutes before the anticipated end of the bypass.
