Tinzaparin (Innohep) 175 IU/kg subcutaneously once daily. It is crucial that the patient is weighed accurately to allow calculation of the correct dose. (Most wards have a calculation chart). Routine measurement of APTT is not necessary. Read the product information leaflet that accompanies this medication. For treatment of DVT and PE, warfarinisation can be started immediately although it is recommended that at least 6 days of Innohep are given. Usually, loading doses of 10 millegrammes, 10 millegrammes, 5 millegrammes of Warfarin are given on the first three days, after which the dose is altered depending on daily prothrombin results.
Heparin may also be given by continuous infusion, usually with a bolus dose of 5,000 IU followed by 1,000 IU per hour. The APTT should be checked before starting and 4 hours after commencing the infusion. The dose is then adjusted to keep APTT between 2-3 times normal. Continuous infusion of heparin is frequently used in vascular patient either pre or post operatively. The dose and duration may depend on the timing of angiography, surgery and the amount of heparin given intra-operatively. It is essential that the heparin dose given on the ward should be discussed with the surgeon responsible for the patient.