Weight based heparin protocol pdf file

Unfractionated heparin ufh is used intravenously when therapeutic anticoagulation is warranted and low molecular weight heparin is not a suitable option. Weight based argatroban dosing nomogram for treatment of heparininduced thrombocytopenia article pdf available in annals of pharmacotherapy 431. It is appropriate to use abw in a weight based heparin dosing protocol for obese patients. The purpose of this tool kit is to provide evidenced based recommendations and best practices on setting and managing. A weight based heparin protocol also 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. The following guideline provides recommendations for. Perhaps the most striking aspect of our protocol is the relatively small ufh loading dose of 26 unitskg, compared with the 80unitskg dose promoted by the american college of chest physicians.

Use of an algorithm for administering subcutaneous heparin in. Discharge where enoxaparin is prescribed on discharge, the prescriber must provide clear instructions to the patients gp regarding the. Valley hospital somewhere texas heparin treatment protocol weight based physician. Exemplars used this week are htn, cad, and acute mi 1. Vailoces, year1999 heparin is an anticoagulant widely used for the treatment and prevention of. Heparin 5000 units sq every 8 to 12 hours class i, level b extreme obesity patients bmi 40 kgm2 enoxaparin 40 mg sq every 12 hours class iia, level b low body weight patients weight 50 kg enoxaparin 30 mg sq every 24 hours class iib, level c or heparin 5000 units sq every 8 to 12 hours class i, level b 3.

Guideline for anticoagulation and prophylaxis using low. Unfractionated heparin infusion protocol hospital quality institute. To evaluate the effect of a postpartum risk based lowmolecular weight heparin protocol for venous thromboembolism prevention. Limitations of a standardized weightbased nomogram for. This protocol is designed to guide clinicians in fulfilling the following objectives. Obtain ptt 6 hours after initiation of heparin and after any subsequent changes until therapeutic x 2, then every am.

The current heparin infusion protocols prescribing patterns. Pharmacist may order baseline labs if provider has not already done so. These changes warranted reevaluation of the standard and lowertarget protocols. Only the heparin dose given over the last 34 hours needs to be included in the protamine dose calculation. University hospital adult weight based iv heparin protocols name the 3 heparin drug orders involved with each protocol describe the heparin rate adjustment nomograms identify patients that may be exhibiting signs of hit. Unfractionated heparin infusions were titrated to an aptt goal of 60 to 80 seconds based on the standard institutional nursedriven titration nomogram. This article describes the pharmacology of approved parenteral anticoagulants. The weightbased heparin dosing nomogram compared with a. In this course, the term heparin refers to both lmwh and ufh, unless otherwise specified. Do not start in patients who have had tpa, for ischemic stroke, within 24 hours. Your patient is currently receiving an infusion based on 18unitskghour.

In the older version, the nurse accessed a computer menu of eight variations of the heparin protocol. Therefore, it is appropriate to use abw in a weightbased heparin dosing protocol for this. Source plasma and is then purified, heattreated, nanofiltered, and lyophilized into a powder for reconstitution. Heparin iv infusion protocol and orderset approved changes. Implementation of a riskbased heparin protocol for postpart. Intravenous iv ufh has an immediate onset of action but requires monitoring and infusion rate adjustments in order to achieve a targeted therapeutic range5. Therapeutic dosing of unfractionated heparin adult. Neither nor any other party involved in the preparation or publication of this. View test prep heparin practice problems answers rev 3 cd1. Adult heparin drip protocol this protocol reflects current evidence based clinical practice.

Low molecular weight heparin predictable pharmacokinetics simple dosing. Anticoagulant therapy vanderbilt university medical center. Average weight methodology in weight basedunfractionated heparin therapy in the presence of obesity to the editor. Tips round off doses to reasonable numbers that staff can work with for example, do not select a dose of 1273. Efficacy of rd heparin a lmwh and warfarin for prevention of. 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. The cec recommends use of premix infusion bags for. Heparin infusion guidelines anticoagulation services. Pharmacymanaged, weightbased heparin protocol american. The phase iipp group excluded all patients who received ufh for an indication other than vte, stroke. Achievement of anticoagulation by using a weightbased heparin. The effectiveness of implementing the weightbased heparin. Begin therapy with warfarin at a dose of 5 mg or less per day with dosage adjustments based on serial inr determinations. Order standard heparin infusion with starting rate defaulted based on indication.

In 1996, a weight based protocol for administration of heparin was implemented and assessed at the authors institution. For patients on heparin unfractionated or low molecular weight. Ufh is a heterogeneous mixture of glycosaminoglycans that bind to antithrombin. Mitigation of benefit is likely to occur when practice guidelines are moved from the realm of efficacy research into clinical practice. In general, weight based nomograms are much more likely to achieve therapeutic levels within 48 hours. Heparin infusion algorithms anticoagulation services. 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. This protocol was updated in june 2009 to include dosage adjustments based on the results of a heparin assay test. Discontinue heparin if platelets decrease by 50% from baseline and proceed with hit protocol. Therefore, it is appropriate to use abw in a weight based heparin dosing protocol for this. It is not a substitute for appropriate clinical evaluation and does not supersede clinical judgment.

Anticoagulation protocol federal bureau of prisons. Calculate the starting rate of the infusion mlhour. Evaluation of current heparin weight based protocol. Heparin iv weight based protocol, constant indicator. Evaluation of 2 weightbased protocols for administration of heparin. It is important to note that the most critical factor in reducing the risk of recurrent thromboembolism is reaching a therapeutic ptt within 2448 hours. One difficulty with the use of weight adjusted ufh nomograms is the wide variation of aptt 143s table 1. Dec 19, 2014 this feature is not available right now.

Patients age 18 years or older receiving heparin therapy for greater than or equal to 24 hours identified. Lowmolecular weight heparin enoxaparin vs dextran 70. Implement weightbased heparin protocols ihi institute. The purpose of this bop anticoagulation protocol is to outline a recommended approach to therapeutic anticoagulation that minimizes the risk of both thromboembolic and bleeding events.

The weight based heparin nomogram was well accepted by clinicians at our institution and led to more aggressive heparin dosing and improvements in intermediate outcomes, without increasing bleeding. Heparin dosing calculator custom options available. Evaluation of current heparin weight based protocol in obese patients. Evaluation of current heparin weight based protocol in obese. Identify factors andor comorbidities affecting andor contributing to perfusion. Guideline for anticoagulation and prophylaxis using low molecular weight heparin lmwh in adult inpatients. A weightbased heparin protocol also helps provide timely adjustments to dosages, which in turn helps to decrease the risk of adverse drug events. This recommended standard is based on premix infusion bag of heparin 25,000 units in 250 ml normal saline 100 units per ml. Define laboratory monitoring of unfractionated ufh and low molecular weight heparins lmwh identify how to adjust heparin based upon protocol orders identify situations that increase the risk for heparin associated errors important note. Adult heparin drip protocol ventura county, california. Heparin dosing nomograms began to appear in the literature as early as 1985, although it was not until 1993 that a weight based dosing protocol began to.

Traditional regimens that normally begin with uhr are less likely to achieve this. Founded in 1991, the ihi recommends that clinicians use heparin protocols based on the patients weight. We applaud the recent updates to the ninth edition of the american college of chest physicians on antithrombotic therapy. Override soft stop alert the infusion pump feature that provides the clinician the opportunity to proceed with an infusion after a soft stop alert is reached and allows the. Tga approvals and indications on the pbs for dalteparin and enoxaparin dalteparin enoxaparin. Kcentra is dosed according to factor ix potency and is individualized based on the patients baseline international. Venous thromboembolism prophylaxis adult inpatient. Heparin as a bridge to warfarin in conditions such as acute venous thromboembolism, patients should receive unfractionated heparin or lowmolecular weight heparin during the first few days of warfarin therapy as a bridge, as warfarin may take up to 5 days to achieve its antithrombotic effect. Achieving target antifactor xa activity with a heparin. Subsequent adjustments of the subcutaneous heparin dose were scheduled twice daily according to the algorithm. Since then, several modifications have been made, including introduction of a lowertarget protocol. Venous thromboembolism prophylaxis adult inpatientambulatory. Your patient has a dvt is ordered for a heparin infusion to start at 18 unitskg hour. Evaluation of 2 weightbased protocols for administration.

College lab week 1 objectives unit i perfusionrelated to alterations in perfusion weekly course objectives. Dose adjustments to be made based on aptt ratio aptt sec. However, this method clearly does not represent optimal anticoagulation. Apr 24, 2020 heparin protocols are standardized procedures personnel at a hospital or clinic follow when they administer heparin to reduce the chance of errors. Identify commonly used treatments, identified by standards of care, for patients. To evaluate the difference in achieving goal activated partial thromboplastin time aptt within 24 hours utilizing the institutional heparin weight based protocol between obese and nonobese patients.

Achievement of anticoagulation by using a weight based heparin dosing protocol for obese and nonobese patients. Pharmacist continuing education iv anticoagulation. Study design retrospective cohort study at 3 hospitals population adult obese 100kg inpatients 48 hours who received thromboprophylaxis with ufh or enoxaparin intervention. The authors make no claims of the accuracy of the information contained herein. Few studies have compared the effect of weight based heparin protocols in obese and nonobese patients 9,10. Unfractionated heparin and low molecular weight heparin for vte prophylaxis wang tf, et al. This improper use of the weight based dosing nomogram possibly influenced the data and underestimated the efficacy of the weight based data. Kaplanmeier curves for the primary outcomes favored the weight based nomogram p weight based heparin group, 60 of 62 patients 97% exceeded the therapeutic threshold within 24 hours, compared with 37 of 48 77% in the standard care group p 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. Derivation and validation of age and body mass indexadjusted weightbased unfractionated heparin dosing article pdf available in clinical and applied thrombosishemostasis 259. Loading and rebolus doses not rounded to the nearest 1,000 units will be changed by the pharmacist during verification.

American college of chest physicians evidence based. Ptt, ptinr, hgbhct, platelets, chem7, hepatic enzymes. The first 50 patients to receive a ufh infusion per the. Enoxaparin prescribing, administration and monitoring. 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. Only 9 patients, however, weighed 100 kg range 1011. Use best estimate of true weight if unable to weigh patient. Despite the limitations, after changing the iv heparin protocol to weight based dosing, there are numerical improvements in total hours in therapeutic aptt while on the. Heparin is a potent anticoagulant medication, and a patient could become very ill if care providers make a mistake. Derivation and validation of age and body mass index. Pdf derivation and validation of age and body mass index. The extra vasculature present in obese patients appears to have minimal effect on the dosing of heparin. These include the indirect anticoagulants, unfractionated heparin ufh, lowmolecular weight heparins lmwhs, fondaparinux, and danaparoid, as well as the direct thrombin inhibitors hirudin, bivalirudin, and argatroban. In 1996, a weightbased protocol for administration of heparin was implemented and assessed at the authors institution.

Ufh is a heterogeneous mixture of glycosaminoglycans that bind to antithrombin via a unique. Weight based dosing for dvtpe heparin infusion algorithms anticoagulation services. Because the anticoagulant effect of warfarin is delayed, heparin is administered for rapid anticoagulation. Highrisk iv medications dosing limits guidelines of care. Weighing the options for anticoagulation in obesity. Achievement of anticoagulation by using a weightbased heparin dosing protocol for obese and nonobese patients william j. A fixeddose protocol for heparin therapy, in which an initial loading dose and infusion rate were specified by physicians and partial thromboplastin times ptts were determined every 12 hours, was revised to determine dosing based on patient weight and diagnosis and to include more levels of dose adjustment and additional laboratory tests. A ufh dosage protocol based on patient sex, age, height, and weight produced improved initial target antifactor xa levels compared with a weight based protocol. Give dose by slow iv push, never to exceed 50 mg over a 10minute period references 1.

Start the infusion at 2mlshour 1,000 unitshour check aptt ratioaptt sec 4 hours after infusion start. Initiated on enoxaparin for bridging to warfarin treatment. In gross excess, protamine itself acts as an anticoagulant. Protocols create a simple, clear guideline for how to handle this medication and. Evaluation of 2 weightbased protocols for administration of.

We conducted a retrospective cohort study of postpartum women at a safety net hospital before 20, during 2014, and after 2015 implementation of a risk based enoxaparin thromboembolism prevention protocol. To evaluate the difference in achieving goal activated partial. An intravenous bolus of heparin followed by a subcutaneous injection of heparin in doses adjusted for body weight. 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. Achievement of anticoagulation by using a weightbased heparin dosing protocol for obese and nonobese patients. Patients age 18 years or older receiving heparin therapy for greater than or equal to 24. The lower end of the dosing range is used for patients with dvt deep vein thrombosis. Therapeutic dosing of unfractionated heparin adult emergency. Patients age 18 years or older receiving heparin therapy for greater than or. St or non st segment mi with use of thrombolytics or gp iibiiia nursing to complete. Intravenous unfractionated heparin higherbleeding risk protocol 2 commercially prepared premixed heparin solutions risk medicines management policy pd2015029. Outcomes with weight based versus standard heparin dosing nomograms weight based.

V alley h ospital s omewhere t exas heparin treatment protocol weight based physician orders heparin weight based treatment protocol check one standard protocol dvt or pe or acs without thrombolytic or gp iibiiia use or atrial fibrillation. Weightbased heparin protocol using antifactor xa monitoring. Because of the lack of definitive evidence, the ninth edition and the recent update are silent on how to address weight based. The performance of a weight based dosing protocol for unfractionated heparin ufh infusions using antifactor xa monitoring was evaluated. Heparin protocols are standardized procedures personnel at a hospital or clinic follow when they administer heparin to reduce the chance of errors. Order as needed rebolus for subtherapeutic antixa, if warranted. Uw medicine heparin infusion ultra low intensity algorithm 2019. Averageweight methodology in weightbased unfractionated. Heparin protocols three main protocols at vuh lower dose acs, atrial fibrillation, etc. Per the intravenous high intensity heparin nomogram for. Evaluation of current heparin weight based protocol in. The low molecular weight heparins lmwh, dalteparin and enoxaparin, are approved for use in australia through the therapeutic goods administration tga and are listed on the pharmaceutical benefits scheme pbs see table a. Iv heparin safety initiative standardizes protocols.

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