A 60-year-old on a weight-based IV heparin drip for acute pulmonary embolism has serial aPTT results per hospital protocol (target therapeutic range aPTT 60-90 seconds). Review the trend and answer the questions.
Trend
Choose your responses, then check the answer.
Explanation
At 18:00 the aPTT is 142 seconds — supratherapeutic (> 90), placing the patient at significant bleeding risk. Per standard heparin protocols, the nurse HOLDS the infusion for 1 hour, then RESUMES at a reduced rate (typically 3 units/kg/hr lower) and rechecks aPTT in 6 hours. The nurse also assesses for active bleeding (gums, urine, stool, wound site, neuro changes for ICH), and notifies the provider. Increasing the rate (1) or simply continuing (3) is dangerous; obtaining a STAT INR (4) is clinically irrelevant — heparin is monitored by aPTT, not INR.
The single most-tested heparin titration scenario is the supratherapeutic aPTT. The standard response is HOLD-REDUCE-RECHECK with bleeding assessment. Memorize: aPTT therapeutic = 1.5 to 2.5 times control (commonly 60-90 seconds). For severe overshoot or active bleeding, protamine sulfate is the antidote (1 mg per 100 units of heparin given in the last 4 hours, not exceeding 50 mg).
60-year-old on weight-based IV heparin drip for acute submassive pulmonary embolism. Hospital protocol target aPTT 60-90 seconds. Q6H aPTT draws with nurse-driven titration per protocol.
aPTT therapeutic range (heparin) — Target 1.5-2.5 times control, commonly 60-90 seconds depending on hospital reagent and protocol.
Heparin protocol HOLD-REDUCE — Standard response to supratherapeutic aPTT: hold infusion, reduce rate, recheck in 6 hours, assess for bleeding.
Protamine sulfate — Heparin antidote for severe overshoot or active bleeding; 1 mg per 100 units heparin given in the prior 4 hours, max 50 mg per dose.