Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF March 15, 2013 | Archived Issues

Heparin Therapy: Change in PTT Goal Ranges

Pharmacy Focus

The laboratory has changed reagent for the aPTT and PT/INR. There is no impact on the PT/INR values. However, the therapeutic aPTT ranges changed starting Feb. 22.

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Grand Rounds

Click here to view upcoming grand rounds.


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - March 2013 (PDF)

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Heparin Therapy: Change in PTT Goal Ranges

Pharmacy Focus

The laboratory has changed reagent for the aPTT and PT/INR. There is no impact on the PT/INR values. However, the therapeutic aPTT ranges changed starting Friday, Feb. 22, at 10 a.m.

Please see the following Intranet link for the revised protocol dated February 2013: http://web/clinical/clinical-resources/. (You must be on campus or using a secure connection to view the link.)

Table 1: Dosage Changes for Standard Bleeding Risk

Goal aPTT: 65-117 seconds

(corresponding to therapeutic anti-Xa assay/heparin level = 0.3-0.7 units/ml)

aPTT (sec)

Heparin Level (units/ml)

Rebolus/Hold Infusion

Rate Adjustment

Recheck aPTT

≤ 39

<0.1

80 unit/kg bolus

4 units/kg/hour

6

40-64

0.11-0.29

40 units/kg bolus

2 units/kg/hour

6

Goal 65-117

0.3-0.7

No Change

In AM

118-142

0.71-0.89

None

2 units/kg/hour

6

>142

>0.89

Hold 60 minutes

 3 units/kg/hour

6

Table 2: Dosage Changes for Patients at Higher Bleeding Risk, Acute Coronary Syndrome or Hypothermia Patients (omit bolus and rebolus in hypothermia patients)

Goal aPTT: 53-98 seconds

(corresponding to anti-Xa assay/heparin level = 0.21-0.55 units/ml)

aPTT (sec)

Heparin Level (units/ml)

Bolus/Hold Infusion

Rate Adjustment

Recheck aPTT

≤ 39

<0.1

2000 units

2 units/kg/hour

6

40-52

0.11-0.20

None

2 units/kg/hour

6

Goal 53-98

0.21-0.55

No Change

In AM

99-116

0.56 – 0.69

None

1 unit/kg/hour

6

>116

>0.69

Hold 60 minutes

3 units/kg/hour

6

Table 3: Dosage Changes for Post-Op (Cardiac, Vascular), Ventricular Assist Device (VAD) and Trauma Patients

Goal aPTT: 40-60 seconds

(corresponding to anti-Xa assay/heparin level = 0.11-0.27 units/ml)

aPTT (sec)

Heparin Level (units/ml)

Hold Infusion

Rate Adjustment

Recheck aPTT

≤ 39

<0.1

---

1 unit/kg/hour

6

Goal 40-60

0.11-0.27

No Change

In AM

61-75

0.28-0.37

---

0.5 units/kg/hour

6

76-90

0.38-0.49

---

1 unit/kg/hour

6

91-105

0.5-0.61

Hold 60 minutes

2 units/kg/hour

6

>105

>0.61

Hold 60 minutes

3 units/kg/hour

6