Unique Plan Description: Heparin Non DVT/PE (Low dose) Xa Monitoring
Plan Selection Display: Heparin Non DVT/PE (Low dose) Xa Monitoring
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-02-16 07:31:53
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2025-11-10 11:37:29
Available at all facilities: Yes

Heparin Non DVT/PE (Low dose) Xa Monitoring
Admit/Discharge/Transfer
		This plan is to be used for patients with the following diagnoses: atrial fibrillation, chest pain, stroke, MI(NOTE)*
		MH/WH/JE only: Consider using PTT monitoring if enoxaparin/apixaban/rivaroxaban received in previous 48hr.(NOTE)*
Laboratory
	INR - MH/WH/JE
		Stat, spec type = Blood
	PTT - MH/WH/JE
		Stat, spec type = Blood
		T+2;0400, Timed, Q48H, spec type = Blood
	Heparin Anti-Xa Heparin
		Stat, spec type = Blood
		T;N+360, Timed, Q6H, spec type = Blood
IV Solutions
	HEParin 25,000 units/premixed diluent 250 mL
		250 mL, IV
			Comment: conc: 100 units/mL. Titrate according to Low Dose Weight Based Heparin Protocol.  Maximum weight for dosing 110kg.  MAXIMUM INITIAL rate is 1000unit/hr.1)  Anti-factor Xa UFH <than 0.2 units/mL, bolus 60 units/kg & increase rate by 4 units/kg/hr.2)  Anti-factor Xa UFH = 0.2-0.29 units/mL, bolus 30 units/kg & increase rate by 2 units/kg/hr.3)  Anti-factor Xa UFH = 0.3-0.7 units/mL, (therapeutic range) Do not give bolus & do not change rate.4)  Anti-factor Xa UFH = 0.71-0.95 units/mL, do not bolus. Decrease rate by 2 units/kg/hr.5)  Anti-factor Xa UFH = 0.96 units/mL or more, do not give bolus. Stop infusion for 60 mins & decrease rate by 3 units/kg/hr.Upper hard limits for weight based and non-weight based infusions are as follows: 40 units/kg/hour and 3000 units/hour, respectively; if patient needs require exceeding these limits, contact pharmacy and prescriber.MH/WH/JE only: Consider using PTT monitoring if enoxaparin/apixaban/rivaroxaban received in previous 48hr.
		25,000 units, EVERY BAG, 12 unit/kg/hr
Medications
		No IM injections while on anticoagulants(NOTE)*
	HEParin 1000 units/mL injectable soln
		60 units/kg, Injection, IV Push, Once, STAT
			Comment: Dose = 60 units/kg Bolus.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose. Begin heparin bolus and infusion immediately after initial stat labs are drawn.  (MAXIMUM INITIAL bolus = 4000 units)
		60 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 60 units/kg Bolus.  Anti-factor Xa UFH level < 0.2 units/mL, Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose. (MAXIMUM bolus = 6600 units)
		30 units/kg, Injection, IV Push, Q6H, PRN for see comment, T;N+360
			Comment: Dose = 30 units/kg Bolus.  Anti-factor Xa UFH level between 0.2-0.29 units/mL.  Patient on Low Dose Heparin Protocol.  Pharmacy to calculate dose.  (MAXIMUM bolus = 3300 units)
Patient Care
	Notify MD
		T;N, For surgical patients, contact surgeon for approval to start heparin protocol if ordered post surgery
		T;N, if 2 consecutive 60 unit/kg boluses of heparin given and the resulting anti-factor-Xa UFH is not in therapeutic range within 12 hours
		T;N, if 2 consecutive anti-factor-Xa UFHs are greater or equal to 0.96 units/ml
		T;N, if initial stat anti-factor-Xa UFH comes back elevated.
		T;N, If baseline PTT is >42 seconds (5 seconds above upper normal limit of 22-37 seconds).
		T;N, if critical PTT >135.
		T;N, MH/WH/JE only: If patient has received enoxaparin/apixaban/rivaroxaban in previous 48hr and/or has an elevated baseline UFH antiXa level, please contact prescriber/pharmacy to consider switching to PTT monitoring protocol.
	Order Lab
		T;N, Enter orders for anti-factor-Xa UFH Q6Hr timed after initiation of therapy or any dosage change until 2 consecutive anti-factor-Xa UFH in therapeutic range, then q24h in am.
	Avoid IM Injections if possible while on anticoagulants

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase