Open Access
Table 3
Institutional protocol nomogram for high-dose bivalirudin protocol.
| MCS High Intensity Dosing Nomogram |
||||
|---|---|---|---|---|
| aPTT (seconds) | Dosage Adjustments |
Repeat aPTT |
||
| Hold infusion | Drip change | CrCl > 30 mL/min | CrCl < 30 mL/min or CRRT/iHD | |
| aPTT < 45 | n/a | Increase infusion rate by 40% | aPTT in 2 h | aPTT in 4 h |
| aPTT 45–59.9 | n/a | Increase infusion rate by 20% | aPTT in 2 h | aPTT in 4 h |
| aPTT 60–80 | n/a | No Change (therapeutic) | aPTT in 2 h | aPTT in 4 h |
| aPTT 80.1–100 | Hold infusion for 30 mins | Decrease infusion rate by 30% | aPTT in 2 h after resuming | aPTT in 4 h after resuming |
| aPTT 100.1–179.9 | Hold infusion for 60 mins | Decrease infusion rate by 40% | STAT aPTT every hour until aPTT < 100, then aPTT in 2 h after resuming | STAT aPTT every hour until aPTT < 100, then aPTT in 4 h after resuming |
| aPTT >180 | Recheck STAT aPTT as soon as infusion held to make sure the value is not an artifact due to bivalirudin contamination of specimen. After obtaining follow-up aPTT, adjust via nomogram if applicable. If aPTT remains > 180, contact CT Surgery provider to discuss recommendations | |||
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