Heparin

Anticoagulant/Antiplatelet · Anticoagulant

Indications

DVT, pulmonary embolism, unstable angina, acute peripheral arterial occlusion, in extracorporeal circulation and haemodialysis, prevention of mural thrombosis post MI. COVID-19.

Dosage

Adults: Based on 68 kg: LD: 5000 units IV, then 10,000-20,000 units SC. Maintenance: 8000-10,000 units every 8 hr or 15,000-20,000 units every 12 hr. Intermittent IV Injection: LD: 10,000 units. Maintenance: 5000-10,000 units every 4-6 hr. IV Infusion: LD: 5,000 units. Maintenance: 20,000-40,000 units/day. Treatment of pulmonary embolism, unstable angina & acute peripheral arterial occlusion: By IV, loading dose of 5000 units or 75 units/kg (10000 units in severe pulmonary embolism), followed by continuous IV inf of 18 units/kg/hr. Treatment of deep-vein thrombosis: By IV inj, loading dose of 5000 units or 75 units/kg, followed by continuous IV inf of 18 units/kg/hr or by SC of 15000 units every 12 hrs. Thromboprophylaxis in medical patients by SC inj: 5000 units every 8-12 hrs. Thromboprophylaxis in surgical patients by SC inj: 5000 units 2 hrs before surgery, then every 8-12…

Administration

IV: Continuous inf: Infuse via infusion pump. Heparin lock: Inject via inj cap using positive pressure flushing technique. Heparin lock flush soln is intended only to maintain patency of IV devices & is not to be used for anticoagulant therapy. SC: Administer into anterior abdominal wall, above the iliac crest & 5 cm or more away from the umbilicus. To minimize tissue trauma, lift adipose tissue away from deep tissues. Do not move needle while injecting drug & do not massage inj site before or after inj. Apply gentle pressure to the site after withdrawing needle. Use alternate inj sites. Reconstitution: Standard diluent: 25000 units/500 mL D5W (premixed). Minimum volume: 250 mL D5W. For continuous inf, invert container at least 6 times to prevent drug from pooling. Compatibility: Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D5¼NS, D5½NS, D25W, fat emulsion 10%, ½NS,…

Adverse Effects

Bleeding complications, transient alopecia, thrombocytopenia; osteoporosis (long-term therapy), febrile or allergic reactions, hypoaldosteronism, local reaction at injection site.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: May be used in breast feeding. Contraindications: Haemorrhagic diathesis, deficiency of coagulation factors, severe hepatic, renal or pancreatic impairment, severe thrombocytopenia, GI ulcers, hypertension, brain haemorrhage, CNS injury or surgery, cerebral arterial aneurysm, retinopathy, vitreous haemorrhage, ophthalmic surgery, subacute bacterial endocarditis, imminent abortion, spinal or epidural anaesthesia, lumbar puncture; thrombocytopenia (type II) caused by heparin allergy; suspected malignant tumour with risk of bleeding, nephro- and ureterolithiasis, chronic alcohol abuse. Neonates. Precautions: Elderly, thrombocytopenia. Avoid IM inj, organ punctures & angiography, cancer, post-surgical patients, advanced renal or hepatic disease, jaundice.

Interactions

Acetyl salicylic acid, coumarin derivatives, dextran, dipyridamole, NSAIDs, fibrinolytics, penicillin (high dose). IV nitroglycerin, propranolol, digitalis, tetracycline, nicotine, antihistamines.

Advice to Patient

Contact prescriber if there is unusual bleeding or bruising, dark stool, joint pain, back pain, fever, confusion, persistent nausea or GI upset or swelling or pain at injection site. To prevent bleeding, use soft toothbrush, floss with waxed floss, use electric razor, avoid scissors or sharp knives and harmful activities. Avoid drugs that interact with heparin, such as aspirin and ibuprofen. Wear or carry identification card at all times indicating diabetes.

Pharmacokinetics

Onset of action: Anticoagulation: IV: Immediate. SC: Approx. 20-30 min. Absorption: Oral/Rectal: Erratic. SC: Erratic (considered acceptable for prophylactic use). Metabolism: Complex (thought to occur via the reticuloendothelial system primarily in the liver and spleen). Half-life elimination: Premature neonates GA 25-36 wks: 100 units/kg single dose within 4 hrs of birth: 35.5-41.6 min. Dose-dependent: IV bolus: 25 units/kg: 30 min. 100 units/kg: 60 min. 400 units/kg: 150 min. Mean: 1.5 hrs. Excretion: Urine.

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

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