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Titrate Anticoagulant Doses

Laboratory values that indicate coagulation levels in the blood help determine the proper dose of anticoagulant medications. Physicians can direct nurses or pharmacists to titrate or adjust anticoagulant dosages in order to maintain a certain range of those laboratory values. In other words, rather than specifying a particular dose the protocol allows for titration based on — and yielding — actual values (e.g., if aPTT is between 40 and 49, increase dose by 1unit/kg/hour). This method allows for more timely adjustments to dosages and eliminates the need for a physician’s order for every dose adjustment.

Tips

Use protocols, such as a weight-based heparin protocol, that provide complete directions for titrating doses.
Reduce the risk of overdoses by limiting the maximum dose that can be given without a physician order.
Include parameters and criteria that indicate when to contact a physician.
Use pre-printed dosing charts and calculation aids for anticoagulant solutions.

Implement Weight-Based Heparin Protocols
Implement a protocol for using the patient’s weight to determine heparin doses, a method that reliably achieves desired therapeutic effects.
Provide Coagulation Test Results Within Two Hours or at Bedside
Proper dosing of anticoagulants requires close monitoring of laboratory coagulation tests, so timely results are essential.
Reduce Adverse Drug Events Involving Anticoagulants
Careful monitoring and management of anticoagulant medications can help prevent harm from over-coagulation or under-coagulation.
Use Anticoagulation Flowsheets
Recording all of a patient’s anticoagulation information on a flowsheet makes anticoagulation therapy easier for the staff to administer and may reduce the risk of errors.

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Titrate Anticoagulant Doses