Dosing nomogram for UFH for pediatric VTE
| Loading dose∗ | |||
| ≤ 1 y: 75 IU/kg over 10 min (maximum dose 5000 IU) | |||
| ≥ 15 y: 80 IU/kg over 10 min (maximum dose 5000 IU) | |||
| Initial maintenance rate | |||
| <1 y: 28 IU/kg per h | |||
| ≤1 to 15 y: 20 IU/kg per h (or an equivalent IU/kg per h to a maximum rate of 1250 IU/h) | |||
| ≥15 y: 18 IU/kg per h (or an equivalent IU/kg per h to a maximum rate of 1250 IU/h) | |||
| aPTT† (s) | Anti-FXa (IU/mL) | Dose adjustment | Time to repeat anti-FXa/aPTT‡ |
| <50 | <0.1 | Bolus of 50 IU/kg and increase infusion rate by 20% | 4 h after rate change |
| 50-59 | 0.1-0.29 | Increase infusion rate by 10% | 4 h after rate change |
| 60-85 | 0.35-0.7 | No change | 4 h and when there are 2 consecutive levels in goal range then check next day |
| 86-95 | 0.71-0.9 | Decrease infusion rate by 10% | 4 h after rate change |
| 96-120 | 0.91-1 | Hold infusion for 30 min and decrease infusion rate by 10% | 4 h after rate change |
| >120 | >1 | Hold infusion for 60 min and decrease infusion rate by 20% | 4 h after rate change |
| Loading dose∗ | |||
| ≤ 1 y: 75 IU/kg over 10 min (maximum dose 5000 IU) | |||
| ≥ 15 y: 80 IU/kg over 10 min (maximum dose 5000 IU) | |||
| Initial maintenance rate | |||
| <1 y: 28 IU/kg per h | |||
| ≤1 to 15 y: 20 IU/kg per h (or an equivalent IU/kg per h to a maximum rate of 1250 IU/h) | |||
| ≥15 y: 18 IU/kg per h (or an equivalent IU/kg per h to a maximum rate of 1250 IU/h) | |||
| aPTT† (s) | Anti-FXa (IU/mL) | Dose adjustment | Time to repeat anti-FXa/aPTT‡ |
| <50 | <0.1 | Bolus of 50 IU/kg and increase infusion rate by 20% | 4 h after rate change |
| 50-59 | 0.1-0.29 | Increase infusion rate by 10% | 4 h after rate change |
| 60-85 | 0.35-0.7 | No change | 4 h and when there are 2 consecutive levels in goal range then check next day |
| 86-95 | 0.71-0.9 | Decrease infusion rate by 10% | 4 h after rate change |
| 96-120 | 0.91-1 | Hold infusion for 30 min and decrease infusion rate by 10% | 4 h after rate change |
| >120 | >1 | Hold infusion for 60 min and decrease infusion rate by 20% | 4 h after rate change |
Loading dose is not recommended in neonates and in patients at high risk of bleeding
Assumes this reflects an anti-FXa level of 0.35-0.7 IU/mL or a protamine titration on 0.2-0.4 IU/mL.
Because of high intrapatient and interpatient variability in anticoagulant response to UFH, consider checking anti-FXa levels every 4 hours. Changes in renal function or with changes in various types of renal replacement therapies may require dose adjustment.