Infectious Disease Compendium

Drotrecogin alfa (Xigris®)

Pulled from the market in 2011 as repeat studies demonstated it is not better than placebo. 20 grand a course for nothing. A lesson on the importance of remembering that most of medical literature is wrong.

Dosing

CrCl > 80: intravenously at a constant infusion rate of 24 microgram/kg/h for a total duration of infusion of 96 hours. No change for decrease in renal function.

Absolute Contraindications:

Active internal bleeding. Recent (within 3 months) hemorrhagic stroke. Recent (within 2 months) intracranial or intraspinal surgery, or severe head trauma. Trauma with an increased risk of life-threatening bleeding. Presence of an epidural catheter. Intracranial neoplasm or mass lesion or evidence of cerebral herniation.

Relative Contraindications:

Concurrent therapeutic heparin. Platelet count <30,000, even if the platelet count is increased after transfusions. Prothrombin time-INR >3.0. Recent (within 6 weeks) gastrointestinal bleeding. Recent administration (within 3 days) of thrombolytic therapy. Recent administration (within 7 days) of oral anticoagulants or glycoprotein IIb/IIIa inhibitors. Recent administration (within 7 days) of aspirin >650 mg per day or other platelet inhibitors. Recent (within 3 months) ischemic stroke (see CONTRAINDICATIONS). Intracranial arteriovenous malformation or aneurysm. Known bleeding diathesis. Chronic severe hepatic disease. Any other condition in which bleeding constitutes a significant hazard or would be particularly difficult to manage because of its location.

Important side effects

Bleeding bleeding and more bleeding

Important drug interactions

Rants and Screeds

Pearls

The sooner you give it the better.

Treatment of Choice

Use for

Sepsis. THEY SHOULD HAVE AN APACHE II SCORE > 25. THOSE WITH APACHE II < 25 HAVE HIGHER MORTALITY RATES (PubMed).

Web site for calculating APACHE II score.

Don't use for

Class

Recombinant human activated protein C