Indication
ACS, PE, DVT, bridging anticoagulation.
Preparation
25 000 U in 500 mL NS (50 U/mL).
Dilution
25 000 U / 500 mL → 50 U/mL
Rate
Bolus 80 U/kg (max 5000 U), then 18 U/kg/h; titrate to APTT 1.5–2.5× control or anti-Xa 0.3–0.7.
Monitoring
- • APTT q6h until therapeutic, then daily
- • Platelets (HIT screen)
- • Hb
Common errors
- • Confusing low/high concentration vials
- • Missing weight-based bolus
Pearls
- • Protamine 1 mg per 100 U heparin (last 2 h) for reversal
