Practical aspects of treatment with drotrecogin alfa (activated).
In November 2001, drotrecogin alfa (activated) was approved by the US Food and Drug Administration; in August 2002 it was approved by the European Medicines Agency. Since the approval of drotrecogin alfa (activated), however, critical care physicians have been faced with several challenges, namely its costs, selection of patients who are more likely to benefit from it, and the decision regarding when to start drotrecogin alfa (activated) treatment. There are also operational issues such as how to manage the infusion to deliver an effective treatment while minimizing the risk for bleeding, particularly in patients with deranged clotting, at around the time of surgery or during renal replacement therapy. While addressing these issues, this review remains practical but evidence based as much as possible.
Camporota
Luigi
L
Adult Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
Wyncoll
Duncan
D
D018806:APACHE; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage; D002648:Child; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005062:European Union; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications; D008581:Meningitis / Q000150:complications; D008589:Meningococcal Infections / Q000150:complications; D009102:Multiple Organ Failure / Q000188:drug therapy; D010195:Pancreatitis / Q000150:complications; D017410:Practice Guidelines as Topic; D011486:Protein C / Q000191:economics / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D015996:Survival Rate; D013921:Thrombocytopenia / Q000150:complications; D014481:United States; D014859:Warfarin / Q000008:administration & dosage
D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; D014859:Warfarin; D006493:Heparin; C421124:drotrecogin alfa activated; D001241:Aspirin