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 Release 22.0, Sept. 2008
 
Chapter : ch4. Coagulation Section : Unfractionated Heparin Therapy
  Protocols for Heparin Therapy Based on Heparin Dose Response Curve

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Overview :

The protocol based on the heparin dose response curve is similar to that based on the reference range for aPTT, except that the decision points are based on the aPTTs corresponding to known heparin concentrations, rather than based on a multiple of the mean.

 

If the target for aPTT monitoring is based on the heparin response curve, then the therapeutic range for aPTT corresponds to a heparin levels of 0.2-0.3 or 0.2-0.4 IU/mL

 

Example for a heparin response curve:

 

Heparin Dose

aPTT

0.1 IU/mL

38.4 seconds

0.2 IU/mL

55 seconds

0.3 IU/mL

74.5 seconds

0.4 IU/mL

99 seconds

 

If the therapeutic target is based on a heparin level of 0.2 to 0.3 IU.mL, then the therapeutic range should be 55 to 74.5 seconds.

 

  References:

Bick RL. Heparin therapy and monitoring: Guidelines and practical parameters for clinical and laboratory approaches. Clin Appl Thrombosis/Hemostasis. 1996; 2 (suppl 1): S12-S20.

Cruickshank MK, Levine MN, et al. A standard heparin nomogram for the management of heparin therapy. Arch Intern Med. 1991; 151:333-337.

Hirsh J. Heparin. N Eng J Med. 1991; 324:1565-1574.

Hirsh J, Fuster V. Guide to Anticoagulant Therapy Part 1: Heparin. Circulation. 1994; 89:1449-1468.

Hirsh J, Raschke R, et al. Heparin: Mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy and safety. Chest. 1995; 108 (suppl): 258S-275S.

Raschke RA, Reilly BM, et al. The weight-based heparin dosing nomogram compared with a "standarad care" nomogram. Ann Intern Med. 1993; 119: 874-881.

 

 

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