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Action of Heparin
PE
DVT
Atrial fibrillation
Stroke
Adverse Reactions
* Antidote:
Protamine
Sulfate
(1mg/100units
heparin)
If
heparin is not monitored during administration severe adverse reactions can occur
including:
Spontaneous bleeding
Heparin induced thrombocytopenia (HIT), severe immune reaction causes severe
reduction in platelet count and a paradoxical reaction which increases venous and/or
arterial thrombosis.
Implement bleeding precautions and assess for bleeding tendencies:
Route
Duration
IV continuous
Onset
Peak
immediate
5-10 minutes
2-6hrs
Horizon pump must be used & physician must specify heparin dose
to be administered
Heparin/ hour
ML. Hour *
12,100 units
500 units
10ml/hr
15,600 units
650 units
13ml/hr
18,000 units
750 units
15ml/hr
20,400 units
850 units
17ml/hr
21,600 units
900 units
18ml/hr
24,000 units
1,000 units
20ml/hr
26,400 units
1,100 units
22ml/hr
27,600 units
1,150 units
23ml/hr
30,000 units
1,250 units
25ml/hr
31,400 units
1,350 units
27ml/hr
Dosing Regimens
Low Intensity
G
Therapy
(e.g. stroke or high risk for
bleeding)
Moderate Intensity
Therapy (e.g. ACS, A-fib,
Thrombolytic therapy)
High Intensity
Therapy
(e.g. DVT, PE,)
Studies proved that a lower loading dose were just as effective as a higher doses
and the lower doses resulted in decrease adjustments in rate of infusion and
decrease in lab draws.
aPTT is still used merely as a substitute for antifactor Xa test. (less costly)
Q&A
C. Call MD
Q&A
A. CBC
B. Potassium
C. BUN/Cr
aPTT
PT
Q&A
Your pt has a DVT of the right calf and the physician ordered 500ml
D5W with 25,000 units of heparin at 1050 units/hour. Calculate the flow
rate in ml/hr.
A. 18ml/hr
B. 180ml/hr
C. 21ml/hr
D. 50ml/hr
References
American Heart Association. (2001). Guide to Anticoagulant Therapy:
Heparin. Retrieved from:
http://circ.ahajournals.org/content/103/24/2994.full.pdf+html
Bucher, L., Camera, I., Lewis, S. L., McLean- Heitkemper, M., Ruff- Dirksen, S.
(2011). Medical-Surgical Nursing: Assessment and Management of
Clinical Problems. St. Louis: Elsevier/Mosby.
Hazard Vallerand, A., Sanoski, C. A. (2013). Daviss Drug Guide. Danvers: F.A.
Davis Company.
Smith, M. L. & Wheeler, K.E. (2010). Weight-based heparin protocol using
antifactor Xa monitoring. American Society of Health-System
Pharmacist Inc, Volume 67, 371-373. doi: 10.2146/ajhp090123