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    Nomogram For Adjusting Unfractionated Heparin in Adults Using Anti-Factor Xa Activity or The aPTT

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    Nomogram For Adjusting Unfractionated Heparin in Adults Using Anti-Factor Xa Activity or The aPTT

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    Lulwa
    128 views2 pages

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    Nomogram For Adjusting Unfractionated Heparin in Adults Using Anti-Factor Xa Activity or The aPTT

    Uploaded by

    Lulwa

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Nomogram for adjusting unfractionated heparin in adults using anti-factor Xa activity <EM>or*</EM> the aPTT

    Official reprint from UpToDate® www.uptodate.com


    ©2020 UpToDate®

    Nomogram for adjusting unfractionated heparin in adults using anti-


    factor Xa activity or* the aPTT

    Bolus: 80 units/kg (using total body weight)


    Maximum = 10,000 units

    Initial infusion rate: 18 units/kg/hr (using total body weight)


    Maximum = 2000 units/hr

    If using anti- Response If using aPTT*



    factor Xa (seconds)
    activity*
    (IU/mL)

    0.00 to 0.09 Bolus 25 units/kg <40


    Increase infusion by 3 units/kg/hr
    Repeat assay in 6 hours

    0.10 to 0.19 Increase infusion by 2 units/kg/hr 40 to 49


    Repeat assay in 6 hours

    0.20 to 0.29 Increase infusion by 1 unit/kg/hr 50 to 69


    Repeat assay in 6 hours

    0.30 to 0.7 ¶
    NO CHANGE (within therapeutic range) 70 to 110
    Repeat assay in 6 hours
    Once therapeutic for two assays, may change
    to once daily assays

    0.71 to 0.79 Decrease infusion by 1 unit/kg/hr 111 to 120


    Repeat assay in 6 hours

    0.80 to 0.89 STOP INFUSION for 1 hour, then decrease by 121 to 130
    2 units/kg/hr
    Repeat assay 6 hours after restarting the
    infusion

    0.90 to 0.99 STOP INFUSION for 1 hour, then decrease by 131 to 140
    3 units/kg/hr
    Repeat assay 6 hours after restarting the
    infusion

    1.00 to 1.09 STOP INFUSION for 2 hours, then decrease 141 to 150
    by 4 units/kg/hr
    Repeat assay 6 hours after restarting the
    infusion

    - Page 1 of 2
    ≥1.10 STOP INFUSION for 2 hours, then decrease >150
    by 5 units/kg/hr and notify clinician
    Repeat assay 6 hours after restarting the
    infusion

    This is one example of a weight-based heparin dosing nomogram using either anti-factor Xa
    activity or activated partial thromboplastin time (aPTT) for therapeutic heparin dosing (eg, for
    acute venous thromboembolism). All doses are based on actual body weight in kilograms. The
    initial and subsequent bolus doses, infusion rate changes, as well as dosing intensity based on the
    indication for unfractionated heparin (eg, venous thromboembolism, stroke, acute coronary
    syndrome) should be established separately for each institution. Refer to UpToDate for additional
    details.

    aPTT: activated partial thromboplastin time; IU: international units.


    * Only one measurement (the anti-factor Xa activity level or the aPTT) should be used; they are rarely
    concordant.
    ¶ The therapeutic ranges for the aPTT (corresponding to an anti-factor Xa activity of 0.3 to 0.7 IU/mL) are
    dependent on local reagents and instrumentation and must be established by each individual institution.

    Courtesy of Allison E. Burnett, PharmD, PhC, CACP.


    Graphic 122945 Version 2.0

    © 2020 UpToDate, Inc. All rights reserved.

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