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Heparin - full dose therapy in children

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Standard Syringe

The standard heparin infusion mix is:

Wt < 30kg (500 x wt) units heparin diluted to 50 ml with 5% glucose
1 ml/hr = 10 units/kg/hr
Wt ≥ 30kg (200 x wt) units heparin diluted to 50 ml with 5% glucose
1 ml/hr = 4 units/kg/hr

Full Dose Heparin

  • Ensure baseline APTT has been done
  • A normal APTT is 25-37 and 31-55 in neonates
  • Give IV bolus 75 units/kg
  • If more rapid full heparinisation wanted then 100 - 200 units/kg may be given
  • Start infusion at
    • if < 1 year, 28 units/kg/hr
    • if > 1 year and <30 kg, 20 units/kg/hr
    • if ≥ 30 kg, 18 units/kg/hr
  • Monitor APTT every 4 hours until APTT stable
  • Goal APTT is usually 50 - 80
  • Once stable, APTT can be done twice daily

Dose Adjustments for Full Dose Heparin

APTT (sec)  Bolus  (u/kg) Stop Infusion  (min) % Rate Change Repeat APTT
< 40 50 0 + 10 % 4 hours
40 - 49 0 0 + 10 % 4 hours
50 - 80 0 0 0 12 hours
81 - 90 0 0 - 10 % 4 hours
91 - 115 0 30 - 10 % 4 hours
> 115 0 60 - 15 % 4 hours

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Document Control

  • Date last published: 19 April 2010
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: John Beca
  • Editor: John Beca
  • Review frequency: 2 years