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  1. Binds to and activates antithrombin III; given as initial bolus of 5-10,000 units and then 800-1000 units per hour
  2. Incidence of heparin induced thrombocytopenia (HIT) is 10% and is caused by the generation of autoantibodies with anti-heparin platelet factor 4 (PF-4) and can cause thrombosis
    1. NOTE: heparin should be continued during the first 3 days of coumadin therapy since patients are hypercoagulable during the first 3 days of coumadin
  3. Low molecular weight heparins can be administered subcutaneously once or twice a day and are associated with a lower incidence of thrombocytopenia
  4. In patients with confirmed HIT platelet trasnfusion and LMWH are contraindicated; warfarin is not recommended until the platelet count is recovered to at least 100 K/cmm; anticoagulation with direct thrombin inhibitors ( lepirudin, bivalirudin, argatroban) or danaparoid is recommended
  5. Patients with mitral and aortic prosthetic valves and intracranial hemorrhage may be off anticoagulation for 48 hours- to 3 weeks without a significant increase in the stroke rate
  6. For DVT prophylaxis want INR of 2.0, for systemic embolism or mechanical heart valves keep INR 2-4.0
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