desirudin

(des ah' rude in)

Iprivask

Pregnancy Category C

Drug classes
Anticoagulant
Thrombin inhibitor

Therapeutic actions
Selectively inhibits free-circulating and clot-bound thrombin; anticoagulant activity seen
in prolonged clotting time

Indications
• Prevention of DVT in patients undergoing elective hip replacement

Contraindications and cautions

• Contraindicated with allergy to natural or recombinant hirudins; active bleeding;
irreversible coagulation disorders.
• Use cautiously with renal impairment (dosage reduction and frequent monitoring
are suggested); spinal or epidural anesthesia (risk of neuraxial hematoma); hepatic
dysfunction; pregnancy; lactation.

Available forms
Powder for reconstitution—15 mg/vial

Dosages
ADULTS
15 mg q 12 hr by SC injection with the initial dose given 5-15 min prior to surgery but
after induction of regional block anesthesia (if that type of anesthesia is used). Administer
for 9–12 days.
PATIENTS WITH RENAL IMPAIRMENT
For creatinine clearance > 31–60 mL/min, 5 mg q 12 hr, if aPTT exceeds 2 times control,
interrupt therapy until value returns to < 2 times control; for creatinine clearance < 31
mL/min, 1.7 mg q 12 hr, if aPTT exceeds 2 times control, interrupt therapy until value
returns to < 2 times control.
PEDIATRIC PATIENTS
Safety and efficacy not established.

Pharmacokinetics
Route Onset Peak Duration
SC 20–60 min 1–3 hr 2–3 hr
Metabolism: Renal; T1/2: 2 hr
Distribution: Crosses placenta, may enter breast milk
Excretion: Urine
Adverse effects
• CNS: Dizziness, epistaxis, cerebrovascular disorder
• CV: Hypotension, thrombosis, leg edema
• GI: Hematemesis, vomiting
• GU: Hematuria
• Other: Hemorrhage, fever, impaired healing, allergic reactions

Interactions
Drug-drug
• Risk of increased bleeding and hemorrhage if combined with thrombolytics,
anticoagulants, Dextran 40, systemic glucocorticoids, heparins, fractionated
heparins, antiplatelet drugs; monitor aPTT closely if any of these combinations
are used.

Nursing considerations
Assessment
• History: Allergy to natural or recombinant hirudins; active bleeding; irreversible
coagulation disorders, renal impairment, spinal or epidural anesthesia, pregnancy;
lactation
• Physical: T; peripheral perfusion, R, stool guaiac test, partial thromboplastin time
(PTT) or other tests of blood coagulation, (aPTT, PT, INR) urinalysis, CBC

Interventions
• Give first injection 5–15 min before surgery is begun but after spinal anesthesia
induction.
• Give deep SC injections; do not give by IM injection.
• Administer by deep SC injection; patient should be lying down; alternate
administration between the left and right anterolateral and left and right
posterolateral abdominal wall and either thigh.
• Introduce the whole length of the needle into a skinfold held between the thumb
and forefinger; hold the skinfold throughout the injection.
• Apply pressure to all injection sites after needle is withdrawn; inspect injection
sites for signs of hematoma.
• Do not massage injection sites.
• Do not mix with other injections or infusions.
• Store at room temperature; fluid should be clear, colorless to pale yellow.
• Alert all health care providers that patient is using desirudin.
• If thromboembolic episode should occur despite therapy, discontinue and initiate
appropriate therapy.

Teaching points
• This drug must be given by a parenteral route (it cannot be taken orally).
• You and a significant other should learn to administer this drug by SC injection.
 • You should be sitting or lying down when giving the injection.
• You will need to use aseptic technique and have an appropriate process for needle
and syringe disposal available.
• After the desirudin has been reconstituted, it must be used within 24 hr.
• Store the drug at room temperature.
• Do not make up missed doses; if you miss a dose, inject the dose as soon as you
remember and then the next dose in 12 hr.
• Inject the whole length of the needle into a fold of skin held between your thumb
and forefinger. Release the fold of skin after you have finished the injection.
• Do not rub the injection site; rubbing may increase the risk of bruising.
• Alternate injection sites using the front and side of each thigh or the abdominal
wall. Mark the site last used on a calendar or drug information sheet.
• Properly dispose of the syringes as instructed.
• Daily blood tests will be needed to monitor your response to this drug.
• Be careful to avoid injury while you are using this drug—use an electric razor,
avoid activities that might lead to injury.
• Avoid driving or operating hazardous machinery if dizziness occurs.
• Report fever, leg swelling or pain, bleeding, red-tinged urine.

Adverse effects in Italic are most common; those in Bold are life-threatening.