Weight-based Heparin Dosing Guidelines

WEIGHT-BASED HEPARIN GUIDELINES from Beth Israel Deaconess Medical Center compliments of John Halamka (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:

   * 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. 

7. Adjust heparin infusion according to the following sliding scale:

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.

Heparin Dosing Guidelines
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