Anti F Xa in therapeutic range
New Lab Value for Heparin DripsWe will shortly be starting two separate protocols for Heparin drips. One for Acute Coronary Syndrome (ACS) and one for Deep Vein Thrombosis (DVT). There are some slight differences between the two. The ACS protocol is lower, in that the bolus is 60 units/kg and the continuous drip begins at 12 units/kg/hr and the DVT protocol calls for 80 unit/kg bolus and 15 units/kg/hr continuous drip. The new lab value for Heparin drips is called the Anti Factor Xa “Anti factor ten a”The PTT coagulation result can be elevated for several other reasons than just the Heparin infusion. For this reason, we are changing to the Anti F Xa for the protocol at SBMC. The Anti F Xa is also called the Heparin factor, as it directly reflects the amount of Heparin in the patient bloodstream. Though we are using the Anti F Xa, the protocol is essentially the same. There is a goal range of 0.30-0.70. Just like with the PTT, if the range is high the protocol has the Heparin held and restarted at a lower rate. If low the patient is bolused and the drip rate is increased. The importance of anticoagulation is in keeping the patient from forming blood clots that will impede circulation and decrease oxygenation to tissues and cause tissue necrosis. (See next page)Adult Heparin Reference Text - DVT1. D/C IM Injections. No IM injections while on heparin; no Lovenox or Fragmin within 12 hrs.2. Laboratory Orders:-571500117475Note the bolus and drip are higher00Note the bolus and drip are higherSTAT Labs: aPTT, PT, CBC with platelet count. DO NOT begin drip until all Lab results receivedUA and stool occult blood if possible on initiation or within 24 hoursCBC with platelet count at least every 3 daysMeasure Anti F Xa (Anti Factor Xa stated “Anti factor 10a also called the Heparin Factor) 6 hours after any dose increase or decrease. Repeat Anti F Xa in 6 hours if Anti F Xa is therapeuticChange Anti F Xa to every 24 hours if two consecutive Anti F Xa values are within therapeutic range (Anti F Xa 0.30 – 0.70).Readjust heparin drip as needed per protocol.Discontinue the above Lab orders when heparin is D/C’d.3. Heparin Drip (25,000 units/250mL) Use Actual Weight _________ Kg (Maximum: 125 Kg).Heparin Bolus IVP (Use 1000 units/1 mL) 80 units/kg x _______ kg = ________ units (Maximum: 10,000 units) (dose per kg) (bolus dose)DO NOT bolus if aPTT > 50. Start initial drip as calculated belowHeparin Drip (Conc: 100 units/mL) 15 units/kg/hr x _______ kg = ________ units/hr 100 = _______ ml/hr (Max: 2000 units/hr) (dose per kg/hr) (infusion rate)Adjust heparin infusion rate within 1 hour of last blood draw. Adjustments are based on the following sliding scale table. (Round-off doses to the nearest 1 mL). Goal is to maintain Anti F Xa within therapeutic range 0.30 to 0.70 units/mL. For IVP bolus dose, use Heparin 1000 unit/ mL.Anti F Xa (units/ml)Re-Bolus DoseInfusion Rate AdjustmentOrder Anti F Xa Lab AgainROUND BOLUS TO THE NEAREST 100 UNITSROUND DRIP TO THE NEAREST 1 mlAnti F Xa less than 0.2060 units x Wt =_________ units(Max: 10,000 units) Increase rate by 4 units/kg/hr 6 hours after bolusAnti F Xa 0.20 to 0.24NONE Increase rate by 3 units/kg/hr 6 hours after rate changeAnti F Xa 0.25 to 0.29 NONE Increase rate by 2 units/kg/hr6 hours after rate changeAnti F Xa 0.30 to 0.70NONEAnti F Xa in therapeutic rangeIn the morning and QAM (if 2 consecutive values within this range)Anti F Xa 0.71 to 0.80NONEDecrease rate by 1 units/kg/hr 6 hours after rate changeAnti F Xa 0.81 to 1NONE Decrease rate by 2 units/kg/hr 6 hours after rate changeAnti F Xa above 1NONEHOLD DRIP FOR 1 HR, Decrease rate by 3 units/kg/hr 6 hours after rate change4324350116205Yet the therapeutic range is the same Yet the therapeutic range is the same 21526504391025Cerner Screen for Anti F Xa020000Cerner Screen for Anti F XaAdult Heparin Reference Text - ACS1. D/C IM Injections. No IM injections while on heparin; no Lovenox or Fragmin within 12 hrs.2. Laboratory Orders:-514350107950The bolus and drip are lower0The bolus and drip are lowerSTAT Labs: aPTT, PT, CBC with platelet count. DO NOT begin drip until all Lab results receivedUA and stool occult blood if possible on initiation or within 24 hoursCBC with platelet count at least every 3 daysMeasure Anti F Xa (Anti Factor Xa stated “Anti factor 10a also called the Heparin Factor) 6 hours after any dose increase or decrease. Repeat Anti F Xa in 6 hours if Anti F Xa is therapeuticChange Anti F Xa to every 24 hours if two consecutive Anti F Xa values are within therapeutic range (Anti F Xa 0.30 – 0.70).Readjust heparin drip as needed per protocol.Discontinue the above Lab orders when heparin is D/C’d.3. Heparin Drip (25,000 units/250mL) Use Actual Weight _________ Kg (Maximum: 125 Kg).Heparin Bolus IVP (Use 1000 units/mL) 60 units/kg x _______ kg = ________ units (Maximum: 5,000 units) (dose per kg) (bolus dose)DO NOT bolus if aPTT > 50. Start initial drip as calculated belowHeparin Drip (Conc: 100 units/mL) 12 units/kg/hr x _______ kg = ________ units/hr 100 = _______ ml/hr (Max: 1000 units/hr) (dose per kg/hr) (infusion rate)Adjust heparin infusion rate within 1 hour of last blood draw. Adjustments are based on the following sliding scale table. (Round-off doses to the nearest 1 mL). Goal is to maintain Anti F Xa within therapeutic range 0.30 to 0.70 units/mL. For IVP bolus dose, use Heparin 1000 unit/mL.Anti F Xa (units/ml)Re-Bolus DoseInfusion Rate AdjustmentOrder Anti F Xa Lab AgainROUND BOLUS TO THE NEAREST 100 UNITSROUND DRIP TO THE NEAREST 1 mlAnti F Xa less than 0.2060 units x Wt =_________ units(Max: 5,000 units) Increase rate by 4 units/kg/hr 6 hours after bolusAnti F Xa 0.20 to 0.24NONE Increase rate by 3 units/kg/hr 6 hours after rate changeAnti F Xa 0.25 to 0.29 NONE Increase rate by 2 units/kg/hr6 hours after rate changeAnti F Xa 0.30 to 0.70NONEAnti F Xa in therapeutic rangeIn the morning and QAM (if 2 consecutive values within this range)Anti F Xa 0.71 to 0.80NONEDecrease rate by 1 units/kg/hr 6 hours after rate changeAnti F Xa 0.81 to 1NONE Decrease rate by 2 units/kg/hr 6 hours after rate changeAnti F Xa above 1NONE769620300355Therapeutic range is the sameTherapeutic range is the sameHOLD DRIP FOR 1 HR, Decrease rate by 3 units/kg/hr 6 hours after rate change ................
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