Considerations for Medications Commonly Utilized in the Oncology Population in the Intensive Care Unit

Table 9 Oncologic considerations for thrombolytics

Drug	Primary role in therapy	Dosing and administration	Monitoring, adverse events, and toxicities	Drug-drug interactions	Clinical pearls
Defibrotide [69, 117]	Hepatic SOS (VOD)	Dosing IV: 6.25 mg/kg q6h for at least 21 days and a maximum of 60 days (until SOS resolution or hospital discharge) Utilize baseline (dry) weight prior to stem cell transplant or initiation of chemotherapy Administration Administer over 2 h using 0.2 micron in-line filter via a dedicated line	Monitoring Platelets, INR, Fibrinogen AE/Toxicities Hemorrhage, Hypersensitivity reaction CI Active bleeding, hemodynamic instability requiring vasopressor support	Co-administration with systemic anticoagulation or fibrinolytic therapy is contraindicated	• For invasive procedures – discontinue defibrotide at least 2 h prior to procedure; resume treatment once the procedure-related risk of bleeding is resolved • Maintain platelets >30,000, INR <1.5, Fibrinogen >150 to decrease bleeding risk

SOS Sinusoidal obstruction syndrome, VOD Veno-occlusive disease, IV intravenous, INR International normalized ratio, AE: adverse effects, CI Contraindications