Low Intensity Heparin Protocol for ACS

[PharmacistReb]

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For some of you hospital people, what kind of protocol do you all have in place following the initial bolus of heparin?

Our max bolus is 5,000 units for those >83 kilograms. Our initial drip is 12units/kg/hr with a max of 1000units/hr (10cc/hr) as an initial drip rate.

Do any of your hospitals start the initial infusion as >10cc/hr for obese patients. In my experience, our 10cc/hr drip rate does not even get within 10 seconds of our target 50-70seconds for the aPTT for patients who are severely obese. It seems incredibly counterproductive.

 

[pharmleague]

For our low dose heparin protocol, we do a 5000 unit bolus if >67 kg and start drip at 1000 units/hr. We do a 4000 unit bolus if <\= 67 kg and start drip at 800 units/hr. And yes it sometimes does take several boluses and adjustments to get obese people to goal. This will probably need to be addressed at some point as the obese population increases.