Unfractionated Heparin (UFH)

Question 1

What are some characteristics regarding UFH?

Answer 1

-Rapid, parenteral anticoagulant (continuous infusion)
-Variable dose-response –> need aPTT monitoring

Question 2

What is aPTT?

Answer 2

-activated Partial Thromboplastic Time
-Represents how long it takes the blood to clot
-Want it to be somewhat longer but not too long or else it is a bleed risk

Question 3

What is the goal aPTT time?

Answer 3

1.5-2.5 times the control (control will be given by lab)

Question 4

How is UFH dosed?

Answer 4

Weight-based dosing

Question 5

What are adverse effects of UFH?

Answer 5

-Bleeding
-Thrombocytopenia

Question 6

How do you monitor aPTT?

Answer 6

-Monitor at baseline
-6 hours after dose or with each dosage change (for first 24 hours)
-Check daily after the first day - unless out of range
-If out of range go back to checking every 6 hours

Question 7

How do you define Heparin Associated Thrombocytopenia?

Answer 7

-Mild decrease in platelets (platelet count remains above 100,000/mm3)
-Occurs around 48-72 hours after administration of heparin
-Transient (not permanent) so therefore there is no need to d/c heparin

Question 8

How do you define Heparin Induced Thrombocytopenia (HIT)?

Answer 8

-Immune-mediated
-Thrombotic complications
-Occurs between 7-14 days
-PLATELETS DROP >50% FROM BASELINE OR < 100,000/mm3 (KNOW THIS VERY IMPORTANT)

Question 9

How do you manage HIT?

Answer 9

-Stop all heparin products
-Give an alternate anticoagulant (i.e. lepirudin, argatroban, bivalirudin, or fondaparinux)
-Do not give platelet infusions
-Do NOT give warfarin until the platelet count is > 150,000
-Evaluate for thrombosis