title: Adjustment of Heparin dose
text: |
  Adjustment of Heparin dose
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  bet | 259/654 | Sana | 03.01.2022 | Hajmi | 1,5 Mb. | | #14803 |
  Adjustment of Heparin dose
  Anti-Xa is preferred to assess the effect of heparin and guide dosing (Table 1).
  Table 1. Heparin dosing based on anti-Xa levels (therapeutic range 0.3-0.7 unit/mL)(modified from O’Meara et al)3
  Anti-Xa level (unit/mL)
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  Dose adjustment
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  <0.2
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  Increase infusion by 5 units/kg/hour
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  0.2-0.29
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  Increase infusion by 5 units/kg/hour
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  0.3-0.7
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  No change
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  >0.7≤1.0
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  Decrease infusion by 2 unit/kg/hr
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  >1
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  Seek advice from haematologist
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  Measure anti-Xa levels 6 hours after commencing heparin and then 6 hourly until two consequent values are within therapeutic range. After every heparin adjustment or a blood product administration, the anti-Xa level should be checked again in 6 hours and discuss with haematologist on frequency of further monitoring.
  PT/INR, PTT, fibrinogen, platelet count, and ATIII levels are measured daily or as advised by the haematologist.
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  If anti-Xa levels are not available, APTT can be used to guide heparin dosing (Table 2).
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