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1. Obtain patient’s height and weight. If weight is >130% of ideal body weight (IBW) use dosing weight for heparin dosing. Contact pharmacist for all heparin dose calculations.
  a. Dosing Weight= IBW+ (actual body weight-IBW) x 0.4 [Calculated by program]
2. Obtain PTT and INR prior to heparin therapy. If levels elevated, call MD.
3. Obtain CBC prior to heparin therapy. If PLT, HGB, HCT low contact MD.
4. Loading Dose: [Options selected below]
  -heparin 80 units/kg IV push for PE/DVT age <70
  -heparin 70 units/kg IV push PE/DVT (age >70) or TIA/CVA (max of 5000 units)
  -heparin 60 units/kg IV push ACS (max of 5000 units)
  -no bolus
5. Initial Maintenance Dose: Start heparin infusion (25,000 units/250 ml) using IV pump.
Begin immediately after loading dose. [Options selected below]
  18 units/kg/hr PE/DVT age < 70
  15 units/kg/hr CVA/TIA or PE/DVT age geq 70
  12 units/kg/hr ACS
6. Obtain PTT 6 hours after start of heparin infusion
Patient     Location:
    Weight:      Height:
Select desired weight preference based on local protocol

Select Protocol

Standard Infusion Bag

DVT /PE Guidelines

If DVT/PE with risk factors OR CVA/TIA was chosen, please specify dosing guidelines
Initial Load: units/kg    Initial Rate: units/kg/hr
Safety option: Modify if necessary- Used for DVT/PE if selected.

Limit the maximum initial bolus to: units  
Limit the maximum initial infusion rate to: units/hr

Unstable angina / NSTEMI Guidelines

IF UA / NSTEMI selected above, Fill in the section below. 
UA / NSTEMI Limits:
Hold initial loading dose: 
Initial Load: units/kg   Initial Rate units/kg/hr
Max initial bolus: units.  Max initial infusion rate: units/hr
Heparin Dosing Calculator -custom options available  
In general, weight based nomograms are much more likely to achieve therapeutic levels  within 48 hours. It is important to note that the most critical factor in reducing the risk of recurrent thromboembolism is reaching a therapeutic PTT within 24-48 hours. Traditional  regimens that normally begin with 1000 u/hr are less likely to achieve this goal.  


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