The safety profile of drotrecogin alfa (activated)

Fumagalli, Roberto; Mignini, Mariano A

doi:10.1186/cc6157

Critical Care

Table 4 Guidelines for interrupting drotrecogin alfa (activated) infusion for an invasive procedure

From: The safety profile of drotrecogin alfa (activated)

Procedure^a	Pre-procedure: stop DrotAA	Post-procedure: reconsider DrotAA^b
Minor procedure
Arterial line insertion	2 hours before procedure	Immediately afterward
Venous femoral line insertion	2 hours before procedure	Immediately afterward
Re-intubation (tube change)	2 hours before procedure	Immediately afterward
More invasive procedure
Central venous catheter insertion via compressible site (e.g. via femoral vein)	2 hours before procedure	Immediately afterward
Central venous catheter insertion via noncompressible site (e.g. via subclavian or jugular vein)	2 hours before procedure	2 hours afterward
Chest tube insertion or thoracic drainage	2 hours before procedure	2 hours afterward
Gastroscopy (possible biopsy)	2 hours before procedure	2 hours afterward
Lumbar puncture	2 hours before procedure	2 hours afterward
Nephrostomy	2 hours before procedure	2 hours afterward
Paracentesis	2 hours before procedure	2 hours afterward
Percutaneous drainage	2 hours before procedure	2 hours afterward
Sinus puncture	2 hours before procedure	2 hours afterward
Tracheostomy	2 hours before procedure	1 hour afterward
Wound debridement (decubitus ulcer, infected wound, packing changes in open abdomen, etc.)	2 hours before procedure	2 hours afterward
Major procedure
Major surgical procedure^c	2 hours before procedure	Wait 12 hours
Epidural catheter	2 hours before procedure; withhold drotrecogin alfa (activated) while catheter present	Wait at least 12 hours after catheter removal before initiating drotrecogin alfa (activated) infusion
Other
CPR	When beginning CPR	Evaluate neurologic status before resuming drotrecogin alfa (activated). If chest trauma occurred, wait 12 hours

^aThese guidelines assume that the procedures listed (with the exception of initiation of cardiopulmonary resuscitation [CPR]) are non-emergency. For emergency procedures, the drotrecogin alfa (activated; DrotAA) infusion should be discontinued as soon as possible. The subsequent decision regarding whether and when to reinitiate the infusion depends on the type of procedure and the patient's clinical condition. ^bIf no signs and symptoms of bleeding are present and the investigator/clinician feels that there is minimal risk for bleeding complications. ^cA significant surgical procedure that requires the use of an operating room, anesthesia, and so on. DrotAA, drotrecogin alfa (activated). Modified with permission from Laterre and Wittebole [23].

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ISSN: 1364-8535

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