Heparin Infusion Guidelines

UW Medicine Standard Protocols – Initiation Dosing

1. Order standard heparin infusion with starting rate defaulted based on indication.

2. Order Loading Bolus, if warranted.

3. Order goal anti-Xa level (low intensity 0.3-0.5 units/mL or regular intensity 0.3-0.7 units/mL).

4. Order as needed Re-Bolus for subtherapeutic anti-Xa, if warranted.

INDICATION

LOADING BOLUS

(maximum 10,000 units)

INITIAL INFUSION RATE

PRN RE-BOLUS FOR LOW ANTI-Xa LEVEL

(maximum 5,000 units)

FIRST ANTI-Xa LEVEL

Treatment of Acute Thrombosis

(e.g., DVT, PE)

80 units/kg 18 units/kg/hr

Anti-Xa 0.1-0.29 units/mL:
25 units/kg
(maximum 2,500 units)

Anti-Xa < 0.1 units/mL:
50 units/kg
(maximum 5,000 units)

6 hours after starting infusion
Atrial Fibrillation, Valve Replacement, Peri-Procedural Bridging 70 units/kg 15 units/kg/hr
Acute Coronary Syndrome 50 units/kg 12 units/kg/hr
Mechanical Circulatory Support None 15 units/kg/hr None
Acute Ischemic Stroke None 12 units/kg/hr

Ultra Low Intensity Heparin

(anti-Xa goal 0.1-0.3)

None 8 units/kg/hr