Drug dosages Heparin

Dose requirement is variable to produce an APTT of 1.5-3 times control. This usually requires 500-2000IU/h with an initial loading dose of 3000-5000IU.

Low molecular weight heparin

For deep vein thrombosis prophylaxis give 2500IU SC 12-hrly. For anticoagulation of an extracorporeal circuit a bolus of 35IU/kg is given IV followed by an infusion of 13IU/kg. The dose is adjusted to maintain anti-factor Xa activity at 0.5-1IU/ml (or 0.2-0.4IU/ml if there is a high risk of haemorrhage).

For pulmonary embolism give 200IU/kg SC daily (or 100IU/kg bd if at risk of bleeding)

Anticoagulant prostaglandins

Usual range of 2.5-10ng/kg/min. If used for an extracorporeal circulation the infusion should be started 30min prior to commencement.

Sodium citrate

Infused at 5mmol per litre of extracorporeal blood flow.

Warfarin

Start at 10mg/day orally for 2 days then 1-6mg/day according to INR. For DVT prophylaxis, pulmonary embolus, mitral stenosis, atrial fibrillation and tissue valve replacements the INR should be maintained between2 and 3. For recurrent DVT or pulmonary embolus and mechanical valve replacements the INR should be kept between 3 and 4.5.

Activated Protein C (Drotrecogin a activated)

For sepsis, an infusion of 24 pg/kg/h is given for 96h.

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