12/09/2025
🔴Heparin - Unfractionated Heparin (UFH)🫀⤵️
🐦🔥🐦🔥🐦🔥
🔹💉 UFH Overview:
Binds antithrombin III → inhibits thrombin (IIa) & Xa
IV or SQ, short t½, reversible
Indications: VTE tx/prophylaxis, ACS, AFib, ECMO, dialysis, procedures, pregnancy 🤰
⸻
📏 UFH Dosing Protocols:
1️⃣ VTE Treatment Protocols:
A. Weight-Based (High Dose / Full Anticoagulation):
•Bolus: 80–100 units/kg IV
•Infusion: 15–18 units/kg/hr
•Target aPTT: 1.5–2.5× control (monitor q6h until stable)
B. Low Dose Protocol (Renal/Hemorrhagic Risk or Elderly):
•Bolus: 60–70 units/kg IV
•Infusion: 12 units/kg/hr
•Titrate to same aPTT target
C. Fixed Dose Protocol:
•Bolus: 5000 units IV
•Infusion: 1000 units/hr
•Useful when weight unknown or rapid start needed
•Adjust per aPTT
⸻
2️⃣ VTE Prophylaxis (Low Dose SQ):
•5000 units SQ q8–12h
•No lab monitoring needed
•Use in hospitalized, immobile, or postop pts
⸻
🛑 Antidote: Protamine Sulfate
•1 mg neutralizes ~100 units UFH
•Max: 50 mg IV over 10–15 min
•Monitor for hypotension, anaphylaxis
⸻
⚠️ Side Effects:
•Bleeding 🚨
•HIT (Type II) 🧪
•Osteoporosis (long-term) 🦴
•Hyperkalemia
•Transaminitis
•Injection site bruising
⸻
🧠 Pearls:
•No renal dose adjustment
•Monitor aPTT or anti-Xa
•If HIT suspected → STOP heparin → start argatroban/bivalirudin
•Use IV route for rapid on/off (e.g., surgery)
•SQ low dose safe for prophylaxis, even in ESRD
