Heparin Infusion Using AntiXa Monitoring

Provider-Managed Protocol - AntiXa Monitoring

  1. initiate therapy using recommended dosing based on clinical indication (see Heparin Infusion Guidelines)
  2. check AntiXa level (Heparin Activity level) 6 hours after starting infusion
  3. provider must order each dose adjustment - see algoithm below. NOT A NURSE-MANAGED ALGORITHM

SUGGESTED ALGORITHM FOR HEPARIN DOSING USING ANTI-Xa MONITORING

NOT A NURSE-MANAGED ALGORITHM

Heparin Activity (AntiXa) Level

PRN Re-Bolus

Change Infusion Rate

Next Heparin Activity (AntiXa) Level

< 0.20 units/ml 25 units/kg once, then increase by 4 units/kg/hr 6 hours after dose adjustment
0.20 - 0.29 units/ml none increase by 2 units/kg/hr 6 hours after dose adjustment
0.30 - 0.70 units/ml none No change in 6 hours x 1, then qAM
0.71 - 0.80 units/ml none decrease by 1 unit/kg/hr 6 hours after dose adjustment
0.81 - 0.99 units/ml none decrease by 2 units/kg/hr 6 hours after dose adjustment
> 1.0 units/ml none

Stop infusion for 1 hour, 

then decrease by 3 units/kg/hr

6 hours after dose adjustment