Last Minute Anti-Coagulation Ish Flashcards
Bolus Dose for UFH fir acute VTE
80 U/kg (Max = 10,000 units)
Initial Infusion Rate for UFH
18 U/kg/kr (Max = 2,300 units/hr)
UFH Maintenance Infusion Rate: Activated Partial Thromboplastin Time (seconds)
< 37 = 80 U/kg bolus then increase infusion by 4 U/kg/hr
37 - 47 = 40 U/kg bolus then increase infusion by 2 U/kg/hr
48 - 71 = No change
72 - 93 = Decrease infusion by 1 - 2 U/kg/hr
> 93 = Hold infusion for 1 hr, and then decrease by 3 U/kg/hr
Hip replacement surgery (prophylaxis): Enoxaparin
- 30 mg SC q 12 hr
- Or
- 40 mg SC q 24 hr
- Extended prophylaxis may be given for up to 3 weeks
Hip replacement surgery (prophylaxis): Dalteparin
Postoperative start: 2,500 units SC given after surgery, and then
5,000 units SC q 24 hr
•
•Or
Preoperative start (evening before surgery): 5,000 units SC
followed by 5,000 units SC 4-8 hr after surgery, and then 5,000
units SC q 24 hr
•
•Or
Preoperative start (day of surgery): 2,500 units SC 2 hr before
surgery, then 2,500 units given 4-8 hr after surgery, and then
5,000 units SC q 24 hr
Knee replacement surgery (prophylaxis): Enoxaparin ONLY
•30 mg SC q 12 hr
Abdominal surgery (prophylaxis): Enoxaparin
•40 mg SC q 24 hr
Abdominal surgery (prophylaxis): Dalteparin
2,500 units SC q 24 hr or 5,000 units SC q 24 hr or 2,500 units
SC followed by 2,500 units SC 12 hr later and then 5,000 units
subcutaneous q 24 hr
Acute Medical Illness (prophylaxis): Enoxeparin
•40 mg SC q 24 hr
Acute Medical Illness (prophylaxis): Dalteparin
•5,000 units SC q 24 hr
Deep Vein Thrombosis (with or without pulmonary embolism): Enoxaparin ONLY
- 1 mg/kg SC q 12 hr
- Or
- 1.5 mg/kg SC q 24 hr
Venous Thromboembolism Treatment in Patients w. Cancer: Dalteparin ONLY
200 units/kg SC q 24 hr for 30 days, followed by 150 units SC q 24 hr
What is contra in LMWH
- obese pts
- pts with renal failure
Enoxaparin has been shown to be ______ in pregnancy
SAFE!
DOACS are ______ recommended in pregnancy
NOTTTTTT
For Heparin and pregnancy
-doesn’t cross placenta but can cause osteoporosis when used for long periods of time
Acute Treatment During Pregnancy and Delivery: SHORT TERM
- LMWH
- Enoxaparin 1 mg/kg SC q 12 hr or 1.5 mg/kg q 24 hr
- Or
- Dalteparin 100 units/kg SC q 12 hr
•Or
•UFH
Initiate using weight-based IV therapy and adjust dose to achieve therapeutic anti-Xa level for at least
5 days
•
Transition to SC adjusted-dose UFH administered q 8-12 hr with mid-interval anti-Xa activity adjusted
to achieve an anti-Xa level of 0.3-0.7 unit/mL [kU/L
Acute Treatment During Pregnancy and Delivery: LONG TERM
- LMWH
- Maintain initial LMWH dose regimen throughout pregnancy
- Or
- Alter LMWH dose in proportion to any weight change (usually gain)
•Or
•UFH
Obtain anti-Xa level at the midpoint of the dosing interval and adjust UFH dose to achieve an anti-Xa
level of 0.3-0.7 unit/mL [kU/L]
How to measure Heparin
aPTT
How to measure Warfarin
PT/INR
If pt experiences HIT, don’t use
LMWH (Enoxaparin), Warfarin, UFH
Most commonly used thrombolytic therapy for pts with PE
alteplase 100 mg infused via peripheral vein over 2 hours
Before thrombolytic therapy for PE…
IV UFH should be administered in full therapeutic doses
Avoid _______ during thrombolytic therapy (3 things)
- phlebotomy
- arterial puncture
- other invasive procedures
aPTT _________ following the completion of thrombolytic therapy
should be measured
During thrombolytic therapy, it is __________ to either continue or suspend IV UFH
acceptable; suspend is most common in the US
