Instructions for use: Ikus - Berlin Heart

Postoperative anticoagulation therapy
Intensive care and aftercare
Oral anticoagulation
After complete stabilization of the patient, conversion to a vitamin K antagonist occurs
(target INR: 3.0 to 3.5). The INR value is checked once daily.
Until the target INR is reached, the simultaneous administration of a vitamin K
antagonist and heparin are necessary (duration approx. 4 days). Once the target value is
reached, the heparin is discontinued. If the value subsequently falls below the normal
value, the patient must immediately be supplied with heparin again:
INR 3.0 to 3.5 Vitamin K antagonist, p.o.
INR 2.2 to 2.9 0.3 ml/kg 2x/d low molecular weight heparin, s.c.
INR 80,000/μl) and bleeding (for infants and young children: no bleeding!).
Note
• If th patient was treated with ECMO for a longer period of time: According to the bleeding,
PTT, thromboelastography and platelet aggregation test, heparin administration begins
approx. 24 h postoperatively or later.
PTT
PTT should be performed every 6 h.
• At a thrombocyte count of 100,000/μl, the target PTT is 60-80s
Thromboelastography
Thromboelastography once per day. If necessary, the result makes a target PTT of
80s necessary:
• If the thrombocyte function is substantially disturbed (e.g. due to hemofiltration):
Target PTT 300,000/μl:
Target PTT >80s
• If fibrinogen >300g/l: target PTT 90-100s
Oral anticoagulation
After complete stabilization of the patient, conversion to a vitamin K antagonist occurs
(target INR: 2.8 to 3.5), initial dose 0.2 mg/kg/d. The INR value is checked once daily.
Until the target INR is reached, the simultaneous administration of a vitamin K
antagonist and heparin are necessary (duration approx. 4 days). After reaching the target
value, heparin is discontinued. If the value subsequently falls below the normal value,
the patient must immediately be supplied with heparin again:
INR 2.8 to 3.5 Vitamin K antagonist, p.o.
INR 2.0 to 2.7 Age-specific dose, s.c.
INR