Drotrecogin review

Drotrecogin alfa is an activated recombinant of a human protein C. The activated Protein C is basically an anticoagulant and therefore vitamin K dependent, and is activated by thrombin. Its main physiologic effect is to provide anti-thrombotic and anti-inflammatory responses during medication. It is also considered as a profibrinolytic in some cases.

As an activated enzyme, the drug is related to thrombosis and ischemic stroke though and may be highly related to hyperlipidemia as well as hypercoagulability.

It is nevertheless highly used for the treatment of sepsis in intensive care units. The main mechanism of action is not completely determined but in vitro testing of the drug would indicate that the activated protein C has an antithrombin effect on the system, inhibiting the Va and VIIIa factors. Further studies have shown that the drotrecogin alfa drug has an anti inflammatory effect by limiting the production of necrotic factors.

The drotrecogin alfa drug is only given to patients who are in an intensive care unit, or those who are waiting transfer to an intensive care unit after a diagnosis of sepsis related to an acute organ dysfunction or the like. The said drug is given to those who are at great risk of dying from massive infection.

Since the drug can cause a high risk of bleeding post medication, the patients who need this drug should be ordered by a certified critical care management-attending physician.

As this drug is very potent and dangerous, the usual drug dosage is computed depending on the patient’s weight. A common computation for the number of milligrams to be medicated would be to determine the weight of the patient in kilograms, multiplied by 24 micrograms per kilogram per hour, multiplied by the total number of hours to be infused, and divided by 1000.

The whole medication regimen should be strict so as to take full effect and minimize the risk of complication to a minimum. A rule of thumb is to distribute the whole medication over a duration of a maximum of 96 hours. Furthermore, one duration infusion would have to be delivered within 12 hours.

Usual side effects that should be looked for would primarily have to be bleeding and ecchymoses. This internal bleeding includes gastrointestinal tract hemorrhage, and the more fatal intracranial hemorrhage. Though this is a common side effect experienced with patients being administered with the drug, it should be monitored under strict supervision.

The said drug may increase the anticoagulant effects of some medications that may lead to increased systemic bleeding. Some of these contraindicated drugs are ibritumomab, prostacyclin, and pentosan polysulfate sodium bases.

There are some indicated drugs that should be avoided at all costs as it may cause death. These drugs are antiplatelet agents, danaparoid, heparin, vitamin K antagonist drugs, and the like.

Special precaution should be given to the diet of the patient undergoing drotrecogin alfa. Foods such as ginseng, feverfew, and garlic may increase the risk of bleeding of patients.

• Molecular formula of drotrecogin alfa is C1786H2779N509O519S29
• Molecular weight is 55000 g/mol

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