Durham VA Medical Center
Weight-Based Heparin Nomogram:
CARDIAC PROTOCOL
Obtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes
Monitor Platelet count daily
Document patient’s weight in kg: ___________
Initial Bolus 60 units/kg
(MAX DOSE 4,000 units)
* Calculations based on
actual body weight
* Round dose to nearest 100
units
* Heparin supplied as
25,000 units/250 mL D5W
Initial Infusion Rate 10-14 units/kg/hour
(MAX INITIAL RATE 1,000 units/hr)
Age
Less than 60 years
60-79 years
80 years or greater
Units/kg/hour
Male
14
12
11
Female
12
11
10
Check initial aPTT 6 hours after starting infusion and then after any rate adjustments.
After two consecutive therapeutic PTTs, may change aPTT checks to qAM.
Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80
aPTT
(seconds)
Bolus
Dose
(units)
Stop Heparin
Infusion
(minutes)
Rate Change
(units/hr)
Next aPTT
(6 full hrs after dose
change)
<40
40-59
60-80**
3,000
0
0
0
0
0
↑ 100 units/hr
↑ 100 units/hr
No change
81-85
86-100
101-150
>150
0
0
0
0
0
30 min
60 min
60 min
↓ 100 units/hr
↓ 100 units/hr
↓ 200 units/hr
↓ 300 units/hr
6 hours
6 hours
6 hrs (if therapeutic
x 2, change checks
to qAM)
6 hours
6 hours
6 hours
6 hours

Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count
by 30% or more from baseline, or counts less than 100,000/mm3, PTT above 101 sec, or
signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG
and needs second verifier.
CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders.
Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.
Durham VA Medical Center
Weight-Based Heparin Nomogram:
CARDIAC PROTOCOL
Obtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes
Monitor Platelet count daily
Document patient’s weight in kg: ___________
Initial Bolus 60 units/kg
(MAX DOSE 4,000 units)
* Calculations based on
actual body weight
* Round dose to nearest 100
units
* Heparin supplied as
25,000 units/250 mL D5W
Initial Infusion Rate 10-14 units/kg/hour
(MAX INITIAL RATE 1,000 units/hr)
Age
Less than 60 years
60-79 years
80 years or greater
Units/kg/hour
Male
14
12
11
Female
12
11
10
Check initial aPTT 6 hours after starting infusion and then after any rate adjustments.
After two consecutive therapeutic PTTs, may change aPTT checks to qAM.
Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80
aPTT
(seconds)
Bolus
Dose
(units)
Stop Heparin
Infusion
(minutes)
Rate Change
(units/hr)
Next aPTT
(6 full hrs after dose
change)
<40
40-59
60-80**
3,000
0
0
0
0
0
↑ 100 units/hr
↑ 100 units/hr
No change
81-85
86-100
101-150
>150
0
0
0
0
0
30 min
60 min
60 min
↓ 100 units/hr
↓ 100 units/hr
↓ 200 units/hr
↓ 300 units/hr
6 hours
6 hours
6 hrs (if therapeutic
x 2, change checks
to qAM)
6 hours
6 hours
6 hours
6 hours

Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count
by 30% or more from baseline, or counts less than 100,000/mm3PTT above 101 sec, or
signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG
and needs second verifier.
CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders.
Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.
Durham VA Medical Center
Weight-Based Heparin Nomogram:
CARDIAC PROTOCOL
Obtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes
Monitor Platelet count daily
Document patient’s weight in kg: ___________
Initial Bolus 60 units/kg
(MAX DOSE 4,000 units)
* Calculations based on
actual body weight
* Round dose to nearest 100
units
* Heparin supplied as
25,000 units/250 mL D5W
Initial Infusion Rate 10-14 units/kg/hour
(MAX INITIAL RATE 1,000 units/hr)
Age
Less than 60 years
60-79 years
80 years or greater
Units/kg/hour
Male
14
12
11
Female
12
11
10
Check initial aPTT 6 hours after starting infusion and then after any rate adjustments.
After two consecutive therapeutic PTTs, may change aPTT checks to qAM.
Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80
aPTT
(seconds)
Bolus
Dose
(units)
Stop Heparin
Infusion
(minutes)
Rate Change
(units/hr)
Next aPTT
(6 full hrs after dose
change)
<40
40-59
60-80**
3,000
0
0
0
0
0
↑ 100 units/hr
↑ 100 units/hr
No change
81-85
86-100
101-150
>150
0
0
0
0
0
30 min
60 min
60 min
↓ 100 units/hr
↓ 100 units/hr
↓ 200 units/hr
↓ 300 units/hr
6 hours
6 hours
6 hrs (if therapeutic
x 2, change checks
to qAM)
6 hours
6 hours
6 hours
6 hours

Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count
by 30% or more from baseline, or counts less than 100,000/mm3, PTT above 101 sec, or
signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG
and needs second verifier.

CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders.
Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.
Durham VA Medical Center
Weight-Based Heparin Nomogram:
CARDIAC PROTOCOL
Obtain Baseline labs: PTT, PT/INR, Hgb/Hct, Platelets, Chem-7, Hepatic enzymes
Monitor Platelet count daily
Document patient’s weight in kg: ___________
Initial Bolus 60 units/kg
(MAX DOSE 4,000 units)
* Calculations based on
actual body weight
* Round dose to nearest 100
units
* Heparin supplied as
25,000 units/250 mL D5W
Initial Infusion Rate 10-14 units/kg/hour
(MAX INITIAL RATE 1,000 units/hr)
Age
Less than 60 years
60-79 years
80 years or greater
Units/kg/hour
Male
14
12
11
Female
12
11
10
Check initial aPTT 6 hours after starting infusion and then after any rate adjustments.
After two consecutive therapeutic PTTs, may change aPTT checks to qAM.
Adjust heparin rate using the following chart (revised 6/2009): Target aPTT 60-80
aPTT
(seconds)
Bolus
Dose
(units)
Stop Heparin
Infusion
(minutes)
Rate Change
(units/hr)
Next aPTT
(6 full hrs after dose
change)
<40
40-59
60-80**
3,000
0
0
0
0
0
↑ 100 units/hr
↑ 100 units/hr
No change
81-85
86-100
101-150
>150
0
0
0
0
0
30 min
60 min
60 min
↓ 100 units/hr
↓ 100 units/hr
↓ 200 units/hr
↓ 300 units/hr
6 hours
6 hours
6 hrs (if therapeutic
x 2, change checks
to qAM)
6 hours
6 hours
6 hours
6 hours

Notify MD for any of the following: Decrease in Hgb by more than 2 g/dL, decrease in Plt count
by 30% or more from baseline, or counts less than 100,000/mm3, PTT above 101 sec, or
signs/symptoms of bleeding or worsening thrombosis. Note: Heparin is a HIGH-ALERT DRUG
and needs second verifier.
CARDIAC PROTOCOL: Physician enters initial Heparin bolus and infusion orders.
Per policy, ICU/ED RN then edits CRPS for rate changes & enters repeat PTT.
Poster developed by CCU nursing team spearheaded by Amber Greene, RN.