Heparin drip nomogram for VTE

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The purpose of this guideline is to provide dosing assistance for unfractionated heparin therapy for the treatment of deep vein thrombosis or pulmonary embolism based on anti-factor Xa values (calibrated for heparin).

University of Michigan Health System Anticoagulation Program

Guideline for Managing Unfractionated Heparin for Treatment of Venous Thromboembolism in Adult Patients Based upon Anti-Factor Xa Levels

Initial Dosing and Dosage Adjustments

Heparin should be dosed based upon actual body weight (kg): ____

  1. Bolus doses (round to nearest 10 units) – Maximum bolus dose = 10,000 units
  • Initial bolus dose 80 units/kg
  • Other initial bolus: _______ units/kg
  • No initial bolus
  • No bolus EVER
  1. Continuous infusion rate (round to nearest 10 units) – Maximum initial rate = 1,800 units/hour
  • Initiate infusion at 18 units/kg/h
  • Other initial infusion rate : _________ units/kg/h
  • Non-weight based initial infusion rate : _________ units/h
  1. Monitoring
  • Draw INR/PT, CBC with platelet count and aPTT prior to starting heparin
  • Draw STAT anti-factor Xa 6 hours after starting heparin
  • Monitor anti-factor Xa and adjust per Weight-Adjusted Heparin Nomogram (target anti-factor Xa 0.3-0.7 units/mL)
  • Platelet count should be monitored daily for a minimum of 2 weeks and hemoglobin/hematocrit at least weekly


Weight-Adjusted Heparin Nomogram



Repeat Heparin

Bolus Dose

Hold Infusion


Rate Change

Repeat Anti-Xa level

Less than 0.2*

80 units/kg†


Increase 1.5 units/kg/h

6 hours


40 units/kg†


Increase 1 units/kg/h

6 hours




No change

6 hours**




Decrease 1 units/kg/h

6 hours



30 min

Decrease 1.5 units/kg/h

6 hours

Greater than or

equal to 1*


60 min

Decrease 3 units/kg/h


6 hours

*Notify physician if 2 consecutive Anti-Xa values are in this range

**When 2 consecutive Anti-Xa values are in therapeutic range (0.3-0.7 units/mL), obtain Anti-Xa assay the next morning and every 24 hours thereafter


† Please ensure physician has not selected “No bolus ever” option above

Special Thanks


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  1. Title: Heparin drip nomogram for VTE
  2. Author:  Michigan Medicine
  3. Source: https://ecosystem.tactuum.com/
  4. License: “CC BY-NC 4.0”

Heparin drip nomogram for VTE,  Michigan Medicine, Dept of Surgery,  “CC BY-NC 4.0”

Last reviewed: 09 June 2021