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Heparinization


Heparin (glycosaminoglycan - sulfa) binds AIII and  decreases clotting, BY INHIBITING THROMBIN 

Method:
1. Baseline pTT 
2. IV bolus ~ 5000 U (80U/kg, nl weight pt is 70kg)
3. Maintenance 18-20 U/kg/hr
4. Monitor pTT q 6 hr. Goal: 1.5 - 2.0 X baseline.

Overdose - protamine sulfate - 1 mg / 100U heparin.

HIT
1. stop heparin
2. argatroban or any - 'rudin' ex. bivalirudin (Angiomax)
3. if presents with DVT in 3 weeks - streptokinase, urokinase, tPA (altepase) or APSAC (antistreplase) USE THESE DRUGS IF THERE IS A PE OR A CLOT YOU WANT TO BUST

A PT WITH PERVIOUS CASE OF HIT -- TO PREVENT FURTHER CLOTTING WE HAVE TO USE THE DIRECT THROMBIN INHIBITORS -- ARGATROBAN OR "RUDIN" DRUGS I MAY HAVE MISSPOKE IN CLASS BUT THIS IS THE STATEMENT I MEANT TO SAY!

Heparin Boarding:

Pregnant person presents with DVT.
1. bed rest
2. bolus for mom and junior (10,000U heparin)*****
3. maintenance 1000U IV / hr to 1.5 - 2.0 X baseline

Pregnant person with new DVT who cannot tolerate IV heparin.
1. Sub Q 36,000U 3X / day

DVT prophylaxis for a pregnant person with hx of DVT.
1. 5000U 2X / day

In all 3 of these cases: 
1. maintain heparin until labor begins.
2. restart heparin at the end of labor and continue for 3 months.

Dr. Scott's mixing rules:
Bolus 5000-7500U
mix 500cc (of normal saline ? - please correct) / 20,000U (1ml = 40U) **** THIS CALC WILL TELL YOU HOW MUCH HEPARIN YOU ARE MIXING IN THE IV TO BE ADMINISTRATED****
20U / kg X 70kg = 1400U / hr or 35 ml / hr
change dose rate up or down as needed at a rate of 2-3 ml / hr
pTT - 1.5 - 2.5X baseline. 

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