*Initiate all orders without checkboxes AND initiate orders with checkboxes only if checked

**Authorization is hereby given to dispense the generic equivalent unless otherwise indicated by physician_____
Title: Therapeutic Heparin Protocol ACS/PCI
Specialty: MHS Pharmacy and Therapeutics Committee
Physician Orders: MHS P005348 (rev 01-20-16)
Page 1 of 2
Heparin (Preferred agent for patient on hemodialysis or CVVH)
Height:
(inches)
Allergies:
Weight:

(Kg)

Admission Status:

Note: Calculations should be made using total body weight

Nursing Care
Laboratory test to be done:
a) Obtain at initiation of therapy
i.
Activated Partial Thromboplastin Time (aPTT) [Order in Meditech as PTT]
ii.
Prothrombin Time (PT)
iii.
CBC (without differential)
Note: if PTT result is desired DO NOT order PTT heparin Neutralization, instead order PTT
b) Obtain aPTT 6 hours after initial heparin administration
c) Draw an aPTT 6 hours after every dose adjustment
d) Obtain an aPTT every 6 hours until the result is within therapeutic range for 2 consecutive times
e) After 2 consecutive therapeutic ranges are obtained, change aPTT to once daily
f) Contact physician if patient has 2 consecutive aPTT outside of therapeutic range
g) Contact physician if platelet count is less than 100,000 per mL or falls by 50% or if hemoglobin decreases by
greater than 2 grams.
h) Obtain CBC without differential daily
Acute Coronary Syndrome (ACS) or Percutaneous Coronary Intervention (PCI)

Initial Heparin Bolus: 60 units/Kg; Maximum dose = 4,000 units

Initial Heparin Drip: Start at 12 units/Kg/hr; Maximum 1,000 units/hour
Acute Coronary Syndrome (ACS) or Percutaneous Coronary Intervention (PCI) Dosing
Initial Heparin IV bolus dose of 60 units per Kg
60 units x _____Kg = _______units
Round dose to closest 500 Units, not to exceed 4,000 units
Rounded initial bolus dose = ______ units
Continuous Heparin IV Infusion of 12 units per Kg/hr
12 units x _____Kg = ______Units/hr (not to exceed 1,000 units per hour)
Use Heparin 25,000 Units per 250 mL

_____ Initial (required)

*POS*
MHS P005348

Patient Label Here

*Initiate all orders without checkboxes AND initiate orders with checkboxes only if checked
**Authorization is hereby given to dispense the generic equivalent unless otherwise indicated by physician_____
Title: Therapeutic Heparin Protocol ACS/PCI
Specialty: MHS Pharmacy and Therapeutics Committee
Physician Orders: MHS P005348 (rev 01-20-16)
Page 2 of 2
Dose Adjustments Acute Coronary Syndrome (ACS) or Percutaneous Coronary Intervention (PCI) Dosing
Adjust heparin infusion rate based on sliding scale listed below:
Rate Adjustment (round dose to the nearest 100 units)
Re-bolus 60 units/Kg (maximum 4,000 units) and increase infusion rate by 2 units/Kg/hr
Increase infusion rate by 2 units/Kg/hr
No change (therapeutic range)
Decrease infusion rate by 2 units/Kg/hr
Stop infusion, recheck PTT in 1 hour, follow algorithm based on repeat PTT

aPTT (seconds)
< 35 seconds
35 - 53 seconds
54-70 seconds
71-105 seconds
> 105 seconds

Labs
Labs Prior to Initiation of Heparin
Prothrombin Time (PT)
CBC without differential
Activated Partial Thromboplastin Time (aPTT) [Order in Meditech as PTT]
Note: if PTT result is desired DO NOT order PTT heparin Neutralization, instead order PTT
AM Labs
CBC without differential daily
Additional Orders
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

_____________
Date (required)

_____________ ________________________
_____________________________________
Time (required) Physician Signature (required) Physician Printed Name First & Last (required)

Citation:
Garcia D, Baglin T, et al. Parenteral Anticoagulants Antithrombotic Therapy and Prevention of Thrombosis 9th Ed:
American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, Chest 2012, pages e24s-e43s
2014 AHA/ACC NSTE-ACS Guideline: A Report of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines: 4.3.2.4. Unfractionated Heparin, page 45.

_____ Initial (required)

*POS*
MHS P005348

Patient Label Here