In july 2017, a new heparin protocol was implemented with changes for weight based dosing. The extra vasculature present in obese patients appears to have minimal effect on the dosing of heparin. In 1998, the us fda approved the low molecular weight heparin. Because unfractionated heparin costs less than lowmolecularweight heparin, the unfractionated heparin regimen is attractive for clinical practice. Heparin infusion guidelines university medical center. Venous thromboembolism prophylaxis adult inpatientambulatory. To address this quality issue and improve clinical value, allina health created a systemwide interdisciplinary team to standardize iv heparin therapeutic guidelines and monitor the impact of the. Order as needed rebolus for subtherapeutic antixa, if warranted. Guideline for anticoagulation and prophylaxis using low molecular weight heparin lmwh in adult inpatients. Weight based heparin dosing standard protocol modified protocol maintenance.
Achievement of anticoagulation by using a weight based heparin dosing protocol for obese and nonobese patients. Discontinue any orders for low molecular weight heparin lmwh lovenox, arixtra, fragmin, or subcutaneous unfractionated heparin. Preparations from porcine or bovine intestinal mucus. Stop heparin infusion for 2 hours prior to starting and check baseline aptt and platelet. Low dose lowmolecularweight heparin for thrombosis. Terms in this set 3 your pt has an order for a heparin bolus of 10,000 u, followed by an iv drip of 18 ukghr. Heparin induced thrombocytopenia hit all patients who are to receive heparin should have a platelet count on the day of starting treatment. Initial heparin infusion rates increased from 1,185 to 1,420 unitshour p weight based protocol in other institutions have been hindered by the significant variability in aptt. This article about unfractionated heparin ufh and lowmolecularweight heparin lmwh is part of the seventh american college of chest physicians conference on antithrombotic and thrombolytic therapy. Based on these pharmacokinetic limitations, heparin therapy is usually restricted to the hospital setting, where its effect can be monitored and its dosage adjusted fre. The anticoagulant potency of heparin is measured as usp umg. Low molecular weight heparins lmwhs are glycosaminoglycans gags of different chain length, molecular weight distribution, and different physiochemical characteristics that result from their diverse methods of preparation, which make them noninterchangeable. Achievement of anticoagulation by using a weight based heparin dosing protocol for obese and nonobese patients william j. Heparin iv drip weightbased vte adult protocol subphase.
Weight based heparin orders for deep venous thrombosis dvt and pulmonary embolism pe obtain ptt, inr, cbc prior to initiating heparin. Iv heparin safety initiative standardizes protocols. Order standard heparin infusion with starting rate defaulted based on indication. Guideline for anticoagulation and prophylaxis using low. Concomitant low molecular weight heparin therapy has been reported, however the limited reversibility of this agent makes it a lesspreferred option compared to standard heparin. Heparin is a heterogeneous mixture of unbranced polysaccharide chains. Dosage calculation using a heparin protocol youtube. See part b of weight based heparin order form initial infusion rate dependent on specific indication 10,000 5005,000250 250 380380 if at 6 hours, ptt is still greater than 120, hold heparin and call physician immediately for further orders. Guidance for the practical management of the heparin. Because the anticoagulant effect of warfarin is delayed, heparin is administered for rapid anticoagulation. Nurse to adjust heparin dosing based on continuous lab monitoring and scale. A seven percent relative improvement in the percentage of patients therapeutic within 24 hours of protocol initiation.
For the obesemorbidly obese patient either total body weight or adjusted body weight can be used. Evaluation of 2 weightbased protocols for administration. Comparison of fixeddose weightadjusted unfractionated. Do not start in patients who have had tpa, for ischemic stroke, within 24 hours.
Ppt heparin powerpoint presentation free to view id. This study sought to determine whether an intravenous iv weightbased ufh dosing nomogram based on an 80unitkg bolus and 18unit. Uh as opposed to fractionated heparin or low molecular weight heparin lmwh. Since then, several modifications have been made, including introduction of.
Evaluation of 2 weightbased protocols for administration of. Therefore, it is appropriate to use abw in a weightbased heparin dosing protocol for this. The risk of bleeding from weight based heparin in surgical patients is unclear. Venous thromboembolism prophylaxis adult inpatient. Adult heparin drip protocol ventura county, california. Unfractionated heparin sodium ufh is used in neurology and vascular surgical patients to treat and prevent thromboembolic occlusions and requires weightbased dosing to achieve a therapeutic range. Fall 2016 heparin sliding scale example fall 20151111.
According to the ihi, a weightbased heparin protocol helps provide timely adjustments to dosages, which in turn helps to decrease the risk of adverse drug events. Then, depending on the patients gender, indication for heparin, and route of heparin administration, the nurse selected one of these eight variations. Ptt 6 hours after heparin is instituted, then per nomogram until ptt is in target range ptt daily once ptt is in target range for duration of heparin infusion cbc every other day while on heparin patient body weight. Patients age 18 years or older receiving heparin therapy for greater than or equal to 24 hours identified. However, determining appropriate dosing by intravenous infusion is highly variable in practice. Your patient is currently receiving an infusion based on 18unitskghour. Watch out for tail chasing, the phenomenon in which the ptt is low, so the dose is raised, but then the ptt is high, so the dose is lowered to where it was before and then the ptt gets low again. All hospitalized patients should be evaluated for both bleeding and vte risk within 24 hours of admission, upon transferring level of care, and periodically during the.
The authors make no claims of the accuracy of the information contained herein. Heparin infusion guidelines anticoagulation services. Give dose by slow iv push, never to exceed 50 mg over a 10minute period references 1. Uw medicine heparin infusion ultra low intensity algorithm 2019. Prior to 2016, heparin dosing was based on standard care nomogram.
Weigh patient and use the patients actual weight for initial pump programming. If your values are above the recommendedmaximum values, then that. Multiple standardized protocols have been adopted, including a weightbased nomogram entailing a loading dose of 80 ukg, followed by an initial infusion rate of 18 ukgh. Then, depending on the patients gender, indication for heparin, and route of heparin administration. Begin therapy with warfarin at a dose of 5 mg or less per day with dosage adjustments based on serial inr determinations. Therapeutic dosing of unfractionated heparin adult emergency. Heparin and lowmolecularweight heparin mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety.
Unfractionated heparin is widely used as anticoagulant therapy for thrombotic disease. Cath lab, the prescriber should sign in the administration chart to signify this. In 1996, a weight based protocol for administration of heparin was implemented and assessed at the authors institution. Removal of recommendations for heparin monitoring and dose titrations using ptt key practice recommendations 1. Weight based heparin dosing for thromboembolic disease is. Timed ptt 6 hours after heparin started, then every 6 hours after any change until two consecutive therapeutic results have been obtained. Evaluation of initial heparin infusion rates for a highdose. Exemplars used this week are htn, cad, and acute mi 1. Secondary to the unpredictable doseresponse of unfractionated heparin. Identify commonly used treatments, identified by standards of care, for patients.
The hospital had a weightbased heparin dosing protocol in place that was adapted from clinical trials involving such dosing methods. Bolus dose bolus dose for patients who have not received heparin within the last 6 hours. College lab week 1 objectives unit i perfusionrelated to alterations in perfusion weekly course objectives. Dec 19, 2014 this feature is not available right now. Founded in 1991, the ihi recommends that clinicians use heparin protocols based on the patients weight. Review the following related to unfractionated heparin ufh, low molecular weight heparins. Weight based heparin did not increase the incidence of hemorrhagic events. Since then, several modifications have been made, including introduction of a lowertarget protocol. The weight based heparin nomogram compared with a standard care nomogram. Because unfractionated heparin costs less than lowmolecular weight heparin, the unfractionated heparin regimen is attractive for clinical practice. This guideline provides recommendations regarding best practice for anticoagulation treatment and prophylaxis of venous thromboembolism for adult inpatients in queensland health facilities using low molecular weight heparins. These changes warranted reevaluation of the standard and lowertarget protocols. Adult heparin drip protocol this protocol reflects current evidence based clinical practice. For patients previously exposed to heparin in the last 100 days, obtain a platelet count 24 hours after starting heparin.
Evaluation of current heparin weight based protocol in obese. It is not a substitute for appropriate clinical evaluation and does not supersede clinical judgment. Implement weightbased heparin protocols ihi institute. Fractionated, low molecular weight heparin lmwh sc administration. Pdf comparison of heparin dosing based on actual body. A free powerpoint ppt presentation displayed as a flash slide show on id. Develop a different weightbased protocol for patients receiving thrombolytics or g2b3a inhibitors, whose heparin doses will need to be lower. The weight based heparin group achieved earlier therapeutic anticoagulation. About europe pmc funders joining europe pmc governance roadmap outreach. Valley hospital somewhere texas heparin treatment protocol weightbased physician. Comparison of 2 weightbased heparin dosing nomograms in. In addition, the clinical haematology department has developed guidelines to support clinicians management of warfarin and low molecular weight heparin clexane. The weightbased heparin nomogram compared with a standard care nomogram. I did not address them, but definitely should have.
However, studies showed that weight based nomogram may be more effective than the standard care nomogram. Intravenous iv ufh has an immediate onset of action but requires monitoring and infusion rate adjustments in order to achieve a targeted therapeutic range5. Develop a different weight based protocol for patients receiving thrombolytics or g2b3a inhibitors, whose heparin doses will need to be lower. Weightbased heparin initiation order form for new starts this order form is to be completed by physician. Select the dose adjustment nomogram based on indication for ufh use 1. Heparin infusion algorithms anticoagulation services. Ufh is a heterogeneous mixture of glycosaminoglycans that bind to antithrombin via a pentasaccharide, catalyzing the inactivation of thrombin and other clotting factors. Identify factors andor comorbidities affecting andor contributing to perfusion. Jul 28, 20 unfractionated heparin is widely used as anticoagulant therapy for thrombotic disease. In 1996, a weightbased protocol for administration of heparin was implemented and assessed at the authors institution. This page contains clinical practice guidelines for the administration of standard heparin infusions, systemic lytic therapy and the management of a blocked central venous access device.
This program supports young clinicians who combine medical. Therefore, it is appropriate to use abw in a weight based heparin dosing protocol for this. Unfractionated heparin infusion protocol hospital quality institute. Sash iv heparin guideline surrey and sussex healthcare. Notify physician if platelet count is less than 100 k, hemoglobin drops by more than 1 gram from baseline, or other abnormal values.
Initial heparin infusion rates increased from 1,185 to 1,420 unitshour p pdf from nurs 3352 at university of texas, arlington. Per the intravenous high intensity heparin nomogram for dvtpe, the infusion dose should be increased by 2 unitskghour. In the older version, the nurse accessed a computer menu of eight variations of the heparin protocol. The predominant anticoagulant property of heparin is based on its interaction with. Smaller heparin chains week 1 objectives unit i perfusionrelated to alterations in perfusion weekly course objectives. Intravenous high intensity heparin nomogram venous. Rates were adjusted on the basis of guidelines provided in the dosing protocol appendix. Unfractionated heparin ufh is used intravenously when therapeutic anticoagulation is warranted and low molecular weight heparin is not a suitable option. Comparison of heparin dosing based on actual body weight in nonobese, obese and morbidly obese critically ill patients article pdf available march 20 with 746 reads how we measure reads. Jan 16, 2016 when a weight based heparin dosing strategy is selected, we suggest total body weight for calculating dose and encourage internal audits of protocol performance. Heparin overview1 heparin is a glycosaminoglycan which inhibits the mechanism that induces the clotting of blood and the formation of stable fibrin. If bolus dose is not to be administered or was administered previously e.
Weight based heparin dosing standard protocol modified protocol maintenance from nurs 3365 at university of texas, arlington. Exam 3 heparin practice problems flashcards quizlet. Based on these pharmacokinetic limitations, heparin therapy is usually restricted to the hospital setting, where its effect can be monitored and its dosage adjusted. Smaller heparin chains weight heparins lmwhs are derived from ufh by chemical or enzymatic. Reference guide for weightbased heparin dosing heparin concentration heparin concentration. Neither nor any other party involved in the preparation or publication of this. Therapeutic dosing of unfractionated heparin adult. Achievement of anticoagulation by using a weightbased heparin dosing protocol for obese and nonobese patients. Adult heparin infusion protocol this protocol reflects current evidence based clinical practice. Evaluation of initial heparin infusion rates for a high. Weight based heparin dosing standard protocol modified. For patients on heparin unfractionated or low molecular weight. Overlap warfarin with heparin for at least 5 days and until the inr is within the therapeutic range for 2 consecutive days.