Weight-based heparin guidelines (Order Supplement)

WEIGHT-BASED HEPARIN GUIDELINES (Order Supplement)
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.