DI Heparin & Enoxaparin

Question 1

What are anticoagulation options for patients who have a history of heparin induced thrombocytopenia (HIT)?

Answer 1

Bivalirudin or Fondaparinux

Question 2

MOA Heparin and Enoxaparin

Answer 2

Inhibition of factor Xa and factor II (prothrombin), this

inhibits the conversion of fibrinogen to fibrin preventing clot formation

Question 3

Enoxaparin Use in UA/NSTEMI

Answer 3

1 mg/kg q12h adjusted for CrCl < 30 ml/min

Duration: Until discharge or PCI (up to 8 days)

Question 4

Enoxaparin Use in STEMI

Answer 4

Fibrinolytics
Age < 75: 30mg IV then 1mg/kg q12h Age > 75 :
0.75 mg/kg q12h
Duration: Until discharge or PCI (up to 8 days)

Question 5

Enoxaparin Use in PCI

Answer 5

Administer additional 0.3mg/kg IV if last dose 8 – 12 hrs before PCI
Duration: Until PCI

Question 6

Should anticoagulation therapy be discontinued or continued after PCI is completed?

Answer 6

Discontinued

Question 7

In what situation(s) would you administer heparin?

Answer 7

Usage during acute limb ischemia (ALI). Must revascularize via:

• Thrombolytics
• Endovascular
• Surgical

Question 8

Heparin Use in UA/NSTEMI

Answer 8

60 units/kg IV bolus then 12 units/kg/hr

Duration: 48 hours or until PCI

Question 9

Heparin Use in STEMI

Answer 9

Fibrinolytic: 60 units/kg IV bolus then 12 units/kg/hour
Duration: Until PCI

Question 10

Heparin Use in PCI

Answer 10

With GP IIbIIIa: 50-70 units/kg IV Bolus
Without GP IIbIIIa: 70-100 units/kg IV Bolus
Duration: Until PCI

Question 11

How is Heparin used in acute treatment of ACS? (OSNAAP)

Answer 11

Anticoagulation: IV unfractionated Heparin for 48 hours until PCI is performed