Diferencia entre revisiones de «Unfractionated heparin»

Revisión del 06:55 21 oct 2011

Background

Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
Half-life is 30-150min
Must give IV (not subq) for acute thromboembolic disease
Safe in pregnancy
Unpredictable anticoagulation effect
- Must monitor w/ PTT; therapeutic range is 1.5-2.5x normal value

Treatment

See:
1. DVT
2. PE
3. ACS

Source

Tintinalli

Authors:

@@ Línea 1: / Línea 1: @@
-==Common Indications==
+==Background==
-DVT, PE, AFIB, ACS
+*Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
+*Half-life is 30-150min
-==Bleeding Risk Factors==
+*Must give IV (not subq) for acute thromboembolic disease
-# Surgery, trauma, or stroke within the previous 14 days.
+*Safe in pregnancy
-# History of peptic ulcer disease, GI bleeding or GU bleeding.
+*Unpredictable anticoagulation effect
-# Platelet count less than 150K
+**Must monitor w/ PTT; therapeutic range is 1.5-2.5x normal value
-# Age > 70 yrs.
-# Hepatic failure, uremia, bleeding diathesis, brain metastases.
-Draw extra blue top prior to starting if concerned about a hypercoaguable state (heparin will interfere with assays)
 ==Treatment ==
-# Bolus - 150 u/kg for PE, and 80-100 u/kg for all other conditions.
+#See:
-# Infuse - 15-25 u/kg/hr (high risk --> 15-18 u/kg/hr; low risk --> 22-25 u/kg/hr)
+##[[DVT]]
-# Sliding scale - PTT in 60-80 range..
+##[[PE]]
-##PTT Bolus/Hold Adjust Heparin
+##[[ACS]]
-##<50 70 u/kg 0 Increase 200 u/hr
-##50-59 0 0 Increase 100 u/hr
-##60-80 0 0 No change
-##81-99 0 0 Decrease 100u/hr
-##>100 0 60min Decrease 200 u/hr
-###If 1st PTT after loading dose is > 100 sec do NOT change the infusion rate unless evidence of bleeding
-# The PTT should be checked 4-6 hrs after a new bolus or any change in the infusion dose.
-# Other LABS to check include stool GUIAC qd and CBC (platelets) qd
-Duration: DVT or PE --> 5 days of heparin (even if the INR is therapeutic earlier in hospital course)
 ==Source ==
-/22/06; DONALDSON (addapted from Lampe)
+Tintinalli
 [[Category:Heme/Onc]]