Heparin and Anticoagulants

Unfractionated heparin (UF) is sometimes used. How would initial therapy with heparin be started and doses adjusted. To that same end, one must also consider monitoring of therapy. Heparin Dosing: Weight-Based Nomogram (80u/kg bolus and 18u/kg/h) initially followed by: aPTT (sec) Dose Change in units/kg/hr Additional Action Next aPTT (hr) <35 (<1.2x mean normal)+4 Rebolus with 80units/kg 6 35-45 (1.2-1.5x mean normal) +2 Rebolus with 40units/kg 6 46-70 (1.5-2.3x mean normal) 0 0 6 (once daily after 1st 24h) 71-90 (2.3-3x mean normal) -2 0 6 >90 (>3x mean normal) -3 Hold infusion 1 hour6 What is the next aPTT check according to the nomogram always 6 hours after a start or change ? • how should you interpret an aPTT of 36 seconds at 6 hours after the last change and what should your plan of action be? • how should you interpret an aPTT of 42 seconds at 2 hours after the last change and what should your plan of action be? How Does the use of LMWH compare to that of UF? Conditioner especially monitoring, ease of use, etc . Next, consider NOACs. What agents are available for DVT and are there advantages / disadvantages compared to: • UF followed by warfarin • LMWH followed by warfarin • Fondaparinux followed by warfarin • How should therapy with warfarin be initiated and monitored ? • If dosage adjustments are necessary, how should they be made? • How should elevated INRs be handled? • Why can't warfarin be used as initial therapy (monotherapy) for DVT? • Can NOACs be used as monotherapy? • What if our patient is pregnant?