Should Not Be Used For Patients With Abnormal Baseline PTT
Obtain baseline PTT, platelet count and CBC.
If starting a new infusion for venous thromboembolism, or for arterial thromboembolism other than acute coronary syndromes:
Give an initial bolus of 80 units/kg
Start the infusion at an initial rate of 18 units/kg
If starting a new infusion for acute coronary syndromes:
Give an initial bolus of 60 units/kg, maximum 4,000 units
Start the infusion at an initial rate of 12 units/kg
If starting a new infusion for stroke:
No initial bolus
Start the infusion at an initial rate of 13 units/kg
If patient is currently on low molecular weight heparin, give the first IV heparin dose 8 hours after the last dose of low molecular weight heparin.
Check PTT and adjust according to sliding scale with the following frequency:
After infusion is begun, check PTT every 6 hours.
After any dose change, check PTT every 6 hours.
When PTT is therapeutic for two consecutive tests, check PTT once daily.
Adjust heparin infusion according to the following sliding scale:
PTT (sec)
Bolus (units/kg)
Hold (min)
Rate Change (units/kg/hr)
Under 40
40
-
Increase infusion rate by 4
41 - 60
20
-
Increase infusion rate by 2
60 - 100*
-
-
- No change
101 - 120
-
-
Reduce infusion rate by 2
Over 120
-
60
Reduce infusion rate by 4
*Therapeutic
Notify house officer if signs of bleeding occur.
This is a general guideline and does not represent a professional standard of care governing providers' obligations to patients. Care is revised to meet individual patient needs.
