Heparin/Lovenox Dosing Guidelines
Heparin Dosing Guidelines
	PTT			Dose			Next aPTT
	Initial dose			80 units/kg bolus, then 18 units/kg/hour
	< 35 seconds (< 1-2x control)			80 units/kg bolus, then increase rate by 4 units/kg/hour			6 hours (assume steady state kinetics)
	35-45 seconds (1.2-1.5x control)			40 units/kg bolus, then increase rate by 2 units/kg/hour			6 hours
	46-70 seconds (1.5-2.3x control)			No change			6 hours
	71-90 seconds (2.3-3x control)			Decrease rate by 2 units/kg/hour			6 hours
	> 90 seconds (> 3x control)			Hold infusion for 1 hour, then decrease rate by 3 units/kg/hour			6 hours
Lovenox Dosing Guidelines
Condition Treating				Dosing				Renal Dosing
Hip/Knee Surgery				30mg subcutaneously every 12 hours				30mg subcutaneously once daily
Hip Replacement				40mg subcutaneously once daily				30mg subcutaneously once daily
Abdominal Surgery				40mg subcutaneously once daily				30mg subcutaneously once daily
Treatment of Outpatient DVT				1mg/kg subcutaneously every 12 hours				1mg/kg subcutaneously once daily
Treatment of Inpatient DVT				1-1.5mg/kg subcutaneously once daily				1mg/kg subcutaneously once daily
Unstable Angina or Non Q-Wave MI				1mg/kg subcutaneously every 12 hours				1mg/kg subcutaneously once daily
Heparin Overdosage Treatment Guidelines
	Following Intravenous Administration
	Since blood heparin concentrations decrease rapidly after administration, adjust the protamine dosage depending upon the duration of time since heparin administration as follows:
	Time Elapsed				Protamine Dose (mg) needed to Neutralize 100 units of Heparin
	Immediate				1-1.5mg
	30-60 minutes				0.5-0.75mg
	> 2 hours				0.25-0.375mg
	Following Subcutaneous Administration
	1-1.5mg of protamine per 100 units of heparin; this may be done by a portion of the dose (ex. 25-50mg) given slowly intravenously, followed by the remaining portion as a continuous infusion over 8-16 hours (the expected absorption time of the subcuteneous heparin dose)
Low Molecular Weight Heparin Overdosage Guidelines
	Note: Anti-factor Xa activity never completely neutralized (maximum: ~60-75%)
	Enoxaparin (Lovenox): 1mg protamine for each mg of enoxaparin; if PTT prolonger 2-4 hours after first dose, consider additional dose of 0.5mg for each mg of exonaparin
	Dalteparin or Tinzaparin: 1mg protamine for each 100 anti-Xa IU of dalteparin or tinzaparin; if PTT prolonged 2-4 hours after initial dose, consider additional dose of 0.5mg for each 100 anti-Xa IU of dalteparin or tinzaparin
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