Heparin Dosing for CRRT

Standard Heparin Dosing Protocol for CRRT

• The American College of Chest Physicians recommends adjusting heparin dose based on aPTT results to maintain the target range of 1.5-2.0 times baseline in patients undergoing Continuous Renal Replacement Therapy (CRRT) 1

Dose Adjustment Considerations

• For patients with renal insufficiency, the American Society of Nephrology prefers standard heparin over low molecular weight heparins as it does not require dose adjustment for renal function (metabolism is primarily hepatic) 2
• In patients with high bleeding risk, consider lower initial doses with careful monitoring, as recommended by the American Heart Association 3

Alternative Anticoagulation Options for CRRT

• For patients with contraindications to heparin, such as heparin-induced thrombocytopenia, the American College of Chest Physicians recommends argatroban with no initial bolus, starting infusion rate of 0.5-1.2 μg/kg/min, and target aPTT 1.5-3 times baseline 1, 4
• The American College of Chest Physicians also recommends bivalirudin with no initial bolus, starting infusion rate of 0.15-0.20 mg/kg/h, and target aPTT 1.5-2.5 times baseline 1, 4

Common Pitfalls to Avoid

• Using fixed-dose regimens rather than weight-based dosing can lead to subtherapeutic anticoagulation, according to the American Society of Nephrology 5
• Failure to achieve therapeutic aPTT within 24 hours is associated with reduced filter life and efficacy, as reported by the American Society of Nephrology 5

Special Considerations

• For patients with heparin-induced thrombocytopenia (HIT), the American College of Chest Physicians prefers argatroban due to its hepatic clearance, especially in the setting of renal insufficiency 1, 4
• Early achievement of therapeutic aPTT is associated with better outcomes and filter survival, according to the American Society of Nephrology 5