-
Lovenox Prophylaxis
Cardiac
Not cardiac
PE
- Lovenox 1 mg/kg q12hr no sub if PE
- Not cardiac 1.5 mg/kg q24hr nte 190 mg/kg
-
Lovenox Prophylaxis
Cardiac
Not cardiac
PE
- Lovenox 1 mg/kg q12hr no sub if PE
- Not cardiac 1.5 mg/kg q24hr nte 190 mg/kg
-
VTE prophylaxis Lovenox
Lovenox 30 mg or 40 mg otherwise they get heparin
-
Chest Pain Lovenox
- Lovenox 1 mg/kg q12hr
- PE change to 1.5 mg q24 hr .
- Above 190 mg change to q12hr
-
Lovenox decrease renal function
Cut off is 30 ml/minute
-
Heparin decreased renal function, cut off
- 20 ml/hr.
- No Lovenox.
- Also applies to dialysis patients.
-
Wt less than 45 kg
- Heparin q12hr.
- No Lovenox.
-
Start therapy.
Check INR.
Do not start if INR
- Therapeutic or > 2
- If this occurs call MD and recommend not to start prophylaxis or therary.
- You need an order to hold or dc
-
When to discontinue therapy for DVT or PE patients?
You need 2 consecutive therapeutic INR to recommend discontinuation of treatment for DVT or PE.
-
When to DC therapy for ACs or
A-Fib patients?
One therapeutic INR
-
NEW anticoag Patient what 3 things to check.
- Correct agent
- correct dose
- correct frequency
-
VTE reason for admission
VTE reason for admission
-
Arixtra when to use
Only on HIT or highly suspected HIT otherwise convert to Lovenox.
Use lovenox for ortho only.
-
Lovenox indications
- Ortho surgery
- Spinal cord injury
- Trauma
Lovenox dose 30mg Total Knee or Spinal cord injury
Lovenox dose 40 mg for total hip or hip fracture
-
VTE moderate risk treatment.
Heparin or mechanical if high bleeding risk.
-
Heparin dose for all medical in-patient admissions.
- Heparin 5,000 units q 8 hours
- CCE < 20 ml/min change to q 12hr
-
Spinal cord injury
Total Knee
Lovenox 30 mg sc q12hr
-
Total Hip or hip fracture
Lovenox 40 mg sc q12hr
-
Anticoag contraindications:
- Active bleeding
- Allergy
- Uncontrolled hypertension.
- Coagulopathy
- HIT
-
Heparin drip tests to monitor therapy
- INR
- CBC
- platelet count
- Stat ptt 6 hr after bolus or change in dose.
-
Warfarin
- Daily INR
- Order a aPTT when 2 consecutive PTTs are in therapeutic range (5-104 secs)
-
Lovenox indications
- Ortho surgery
- Total Knee
- Total Hip
- Fx Hip
- Spinal cord injury
- Trauma
-
Prophylaxis VTE risk factors.
- Surgery
- Trauma (major or lower extremity injury)
- Immobile, lower extremity paresis
- Cancer
- Cancer therapy
- Venous compression- tumor hematoma, arterial abnormality
- Previous VTE
- Increasing age
- Pregnancy and post partum period
- obesity
- estrogen replacement
- Birth control pills
- epo products
- acute medical illness
- nephrotic syndrome
- myeloproliferative disorders
- Central cath
- inherited or acquired thombophilia
-
Lovenox 40 mg
Q24 hr for Total hip
-
Anticoag contraindications
- active bleed
- HTN
- allergy
- history HIT
- recent introcular or intracranial surgery
- spinal tap decreased renal function
- decreased renal function < 10 ml/min
- platelets less than 100,000 units/mm3
-
CCE 20-29 ml/min anticoag to avoid
- NO Lovenox.
- IC Heparin 5,000 units sc q12hr prophylaxis.
- Dialysis= NO LOVENOX
-
>190 kg
- NO Lovenox
- Use Heparin 5,000 units sc q8hr
-
Lovenox dose if BMI >50 kg/m2
Call MD to recommend Lovenox 40 mg q12hr.
-
Clinical Reports what to check for.
wt
cce
total hip
diagnosis
- Wt column for less than 45 kg
- CCE less than 20 ml/min
- CCE 20-29 ml/min change lovenox to Q24hr
- CCE > 30 change lovenox to q12hr
- Total hip dose 40 mg q24hr
- Check diagnosis
- Ortho surgery R/O DVT PE MI/ACS use treatment dose
-
Reports what to check for.
wt
cce
total hip
diagnosis
- Wt column for less than 45 kg
- CCE less than 20 ml/min
- CCE 20-29 ml/min change lovenox to Q24hr
- CCE > 30 change lovenox to q12hr
- Total hip dose 40 mg q24hr
- Check diagnosis
- Ortho surgery R/O DVT PE MI/ACS use treatment dose
-
INR check on reports.
want it between 2-3 x 2 days
-
Heparin:
When to use?
What is the dose?
1- Pt weight less than 45 kg
2-CrCl less than 20 ml/minute
Dose: heparin 5,000 units Q12hr
-
Heparin SC dose in normal renal function?
5000 units q8 hr
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