Difference between revisions of "Unfractionated heparin"

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==Common Indications==
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==Background==
DVT, PE, AFIB, ACS
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*Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
 
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*Half-life is 30-150min
==Bleeding Risk Factors==
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*Must give IV (not subq) for acute thromboembolic disease
# Surgery, trauma, or stroke within the previous 14 days.
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*Safe in pregnancy
# History of peptic ulcer disease, GI bleeding or GU bleeding.
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*Unpredictable anticoagulation effect
# Platelet count less than 150K
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**Must monitor w/ PTT; therapeutic range is 1.5-2.5x normal value
# Age > 70 yrs.
 
# Hepatic failure, uremia, bleeding diathesis, brain metastases.
 
 
 
Draw extra blue top prior to starting if concerned about a hypercoaguable state (heparin will interfere with assays)
 
  
 
==Treatment ==
 
==Treatment ==
# Bolus - 150 u/kg for PE, and 80-100 u/kg for all other conditions.
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#See:
# Infuse - 15-25 u/kg/hr (high risk --> 15-18 u/kg/hr; low risk --> 22-25 u/kg/hr)
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##[[DVT]]
# Sliding scale - PTT in 60-80 range..
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##[[PE]]
##PTT Bolus/Hold Adjust Heparin
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##[[ACS]]
##<50 70 u/kg 0 Increase 200 u/hr
 
##50-59 0 0 Increase 100 u/hr
 
##60-80 0 0 No change
 
##81-99 0 0 Decrease 100u/hr
 
##>100 0 60min Decrease 200 u/hr
 
###If 1st PTT after loading dose is > 100 sec do NOT change the infusion rate unless evidence of bleeding
 
# The PTT should be checked 4-6 hrs after a new bolus or any change in the infusion dose.
 
# Other LABS to check include stool GUIAC qd and CBC (platelets) qd
 
 
 
Duration: DVT or PE --> 5 days of heparin (even if the INR is therapeutic earlier in hospital course)
 
  
 
==Source ==
 
==Source ==
1/22/06; DONALDSON (addapted from Lampe)
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Tintinalli
  
 
[[Category:Heme/Onc]]
 
[[Category:Heme/Onc]]

Revision as of 06:55, 21 October 2011

Background

  • Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
  • Half-life is 30-150min
  • Must give IV (not subq) for acute thromboembolic disease
  • Safe in pregnancy
  • Unpredictable anticoagulation effect
    • Must monitor w/ PTT; therapeutic range is 1.5-2.5x normal value

Treatment

  1. See:
    1. DVT
    2. PE
    3. ACS

Source

Tintinalli