Special Medications Anticoagulation

-Heparin (unfractionated) IV bolus 5000-10,000 Units (100 U/kg) IVP, then 1000-1500 U/h IV infusion (20 U/kg/h) [25,000 U in 500 mL D5W (50 U/mL)]. Check PTT 6 hours after initial bolus; adjust q6h until PTT 1.5-2.0 times control (50-80 sec). Overlap heparin and warfarin (Coumadin) for at least 4 days and discontinue heparin when INR has been 2.0-3.0 for two consecutive days.

-Enoxaparin (Lovenox) 1 mg/kg SQ q12h. Overlap enoxaparin and warfarin as outlined above.

-Warfarin (Coumadin) 5-10 mg PO qd x 2-3 d; maintain INR 2.0-3.0. Coumadin is initiated on the first or second day only if the PTT is 1.5-2.0 times control [tab 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg].

10. Symptomatic Medications: -Propoxyphene/acetaminophen (Darvocet N100) 1-2 tab PO q3-4h prn pain

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