Berlin Heart EXCOR Pediatric VAD, Manual, Page: 161 / 250

Chapter 12 Anticoagulation therapy
Anti Factor Xa
level U/ml? Hold Next
Dose? Dose Change? Repeat Anti Factor Xa?
1.6 - 2.0 yes for 3h decrease dose by 40 % Before next dose then 4h
after next dose
> 2.0 yes, until anti
factor Xa
level is <0.5
U/ml decrease dose by 50% Before next dose is
admini-stered, if >0.5 U/
ml (therapeutic level), do
not give next enoxaparin
dose & repeat anti Xa
level in 12 h. When level
<0.5 U/ml, administer
50 % original dose.
Tab. 12-2 Enoxaparin, low molecular weight heparin dosing (Monagle, P, et al.)
Stage INR Action
Day 1 1.0 - 1.8 0.2 mg/kg orally
Day 2-4 1.1 - 1.3 repeat day 1 loading dose
1.4 - 1.9 50 % of day 1 loading dose
2.0 - 3.0 50 % of day 1 loading dose
3.1 - 3.5 25 % of day 1 loading dose
> 3.5 hold dosing until INR is <
3.5
Tab. 12-3 Warfarin loading dose to maintain an INR of 2.7 - 3.5 (Monagle, P, et al.)
Stage INR Action
Maintenance : = Day 5 and
long term 1.1 - 1.9 increase dose by 40 -50%
2.0 - 2.4 increase dose by 10 %
2.7 - 3.5 no change
3.6 - 4.0 administer next dose at
50 % then restart at 20 %
less maintenance dose
4.1- 5.0 hold one dose then 20 %
less maintenance dose
Tab. 12-4 Warfarin Maintenance Dosing for Day 5 and longer to maintain INR 2.7-3.5
INR 2.7 to 3.5 use only warfarin p.o.
INR < 2.7 use warfarin plus enoxaparin as outlined in section 5 until INR
≥
2.7
Tab. 12-5 Drugs and Dose for specific INR range
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