Heparin Dosing and Lab Monitoring

Ebied, A. M., Axelrod, S. F., Tam, D. J., & Chen, Y. (2020). Intravenous unfractionated heparin dosing in obese patients using anti-xa levels. Journal of Thrombosis and Thrombolysis, 49(2), 206–213.  https://doi.org/10.1007/s11239-019-01942-6

This article discusses the use of weight-based dosing of heparin in obese patients, and whether to dose based on total body weight versus adjusted body weight.  This resource is important as it highlights the need for obtaining the correct dosing orders since heparin infusion is weight-based.

Frazer, A., Rowland, J., Mudge, A., Barras, M., Martin, J., & Donovan, P. (2019). Systematic review of interventions to improve safety and quality of anticoagulant prescribing for therapeutic indications for hospital inpatients. European Journal of Clinical Pharmacology, 75(12), 1645–1657. https://doi.org/10.1007/s00228-019-02752-8 

This research study discusses the safety of anticoagulants, including heparin.  This valuable resource is included in this section because it discusses dosing algorithms and heparin monitoring systems.

Smythe, M. A., Priziola, J., Dobesh, P. P., Wirth, D., Cuker, A., & Wittkowsky, A. K. (2016a). Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. Journal of Thrombosis and Thrombolysis, 41(1), 165–186. https://doi.org/10.1007/s11239-015-1315-2 

This article discusses the basics for managing a heparin infusion.  It is a useful resource that covers dosing, lab monitoring, and therapeutic values.  It also includes a table with questions and guidance statements for many anticoagulants including heparin

Williams-Norwood, T., Caswell, M., Milner, B., Vescera, J. C., Prymicz, K., Ciszak, A. G., Ingle, C., Lacey, C., & Stavrou, E. X. (2020). Design and implementation of an anti–factor xa heparin monitoring protocol. AACN Advanced Critical Care, 31(2), 129–137. https://doi.org/10.4037/aacnacc2020132

This study discusses lab values, specifically anti-Xa, in monitoring heparin levels in those receiving heparin infusions.  This resource explains why anti-Xa lab values or used instead of partial thromboplastin time (ptt).