Weight-based heparin guidelines (Order Supplement)



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tarix21.04.2017
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#14803

WEIGHT-BASED HEPARIN GUIDELINES
(Order Supplement)





Should Not Be Used For Patients With Abnormal Baseline PTT

  1. Obtain baseline PTT, platelet count and CBC.

  2. 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

  3. 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

  4. If starting a new infusion for stroke:

    • No initial bolus

    • Start the infusion at an initial rate of 13 units/kg

  5. 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.

  6. Check PTT and adjust according to sliding scale with the following frequency:

  7. 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

  8. 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.

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