IntravenousPrevention of clotting during haemodialysisAdult: Initially, 1,000-5,000 units given as a bolus inj followed by continuous infusion of 1,000-2,000 units/hour, adjust dose as needed. Dosage recommendations may vary between countries (refer to specific country guidelines).
IntravenousPeripheral arterial embolism, Pulmonary embolism, Venous thromboembolismAdult: Initially, 75-80 units/kg or 5,000 units (10,000 units for severe pulmonary embolism) given via bolus inj, followed by continuous infusion of 18 units/kg/hour or 1,000-2,000 units/hour. Alternatively: Continuous infusion: Initially, 5,000 units via bolus inj, followed by continuous infusion of 20,000-40,000 units over 24 hours. Intermittent inj: Initially, 10,000 units followed by 5,000-10,000 units 4-6 hourly. Dosage is individualised and adjusted according to response. Dose and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Elderly: Dosage adjustment may be needed.
Child: >1 year Initially, 75-100 units/kg via bolus inj over 10 minutes, followed by 18-20 units/kg/hour. Dosage is individualised and adjusted according to response. Dose and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
ParenteralMaintaining patency of indwelling intravenous lineAdult: As heparin flush solution: 10-200 units administered into the catheter/cannula 4-8 hourly or as necessary. Recommendations may vary among countries and individual products (refer to specific product guidelines).
SubcutaneousPulmonary embolism, Venous thromboembolismAdult: Initially, 333 units/kg, followed by 250 units/kg (10,000-20,000 units) 12 hourly or 8,000-10,000 units 8 hourly. Alternatively, 10,000-20,000 units for 1 dose (proceeded by 5,000 units IV loading dose), followed by 8,000-10,000 units 8 hourly or 15,000-20,000 units 12 hourly.
Elderly: Dosage adjustment may be needed.
SubcutaneousProphylaxis of postoperative venous thromboembolismAdult: 5,000 units given 2 hours before surgery, then 8-12 hourly for 7 days or until the patient is ambulant.
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Incompatible with fat emulsions, alteplase, amikacin sulfate, amiodarone hydrochloride, ampicillin Na, aprotinin, benzylpenicillin K or Na, cefmetazole Na, cefalotin Na, ciprofloxacin lactate, cisatracurium besilate, cytarabine, dacarbazine, daunorubicin hydrochloride, diazepam, dobutamine hydrochloride, doxorubicin hydrochloride, droperidol, erythromycin lactobionate, gentamicin sulfate, haloperidol lactate, hyaluronidase, hydrocortisone Na succinate, kanamycin sulfate, labetalol hydrochloride, levofloxacin, methicillin Na, nicardipine hydrochloride, netilmicin sulfate, oxytetracycline hydrochloride, polymyxin B sulfate, reteplase, streptomycin sulfate, tetracycline hydrochloride, tobramycin sulfate, vancomycin hydrochloride, vinblastine sulfate, vinorelbine tartrate; certain opioid analgesics, phenothiazines.
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Hypersensitivity. Severe thrombocytopenia, history of heparin-induced thrombocytopenia with or without thrombosis, uncontrolled active bleeding, risk factors for major haemorrhage; septic endocarditis. Locoregional anaesthesia in elective surgical procedures, insertion of epidural anaesthesia (in patients receiving heparin for treatment).
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Patient with increased risk of haemorrhage (e.g. subacute bacterial endocarditis, congenital or acquired bleeding disorders, active ulcerative or angiodysplastic gastrointestinal diseases, severe uncontrolled hypertension); diabetes mellitus, history of hyperkalaemia, history of metabolic acidosis; antithrombin deficiency. Neonates, children, and elderly. Renal and hepatic impairment. Pregnancy and lactation.
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Significant: Hyperkalaemia, increased serum aminotransferases; osteoporosis (prolonged use); mild thrombocytopenia.
General disorders and administration site conditions: Inj site reaction.
Investigations: aPTT prolonged beyond therapeutic range.
Reproductive system and breast disorders: Priapism.
Skin and subcutaneous tissue disorders: Erythema, rash, urticaria, pruritus, skin necrosis.
Potentially Fatal: Haemorrhage, heparin-induced thrombocytopenia with or without thrombosis.
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Monitor Hb, haematocrit, platelet count, prothrombin time, aPTT, faecal occult blood test, K levels. Monitor for signs and symptoms of bleeding and risk factors for bleeding; hypersensitivity reactions, chest pain, and hyperkalaemia.
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Symptom: Haemorrhage. Management: Discontinue treatment for minor cases. Administer protamine sulfate for severe cases.
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Enhanced anticoagulant effect with other drugs affecting platelet function or the coagulation system (e.g. platelet aggregation inhibitors, thrombolytic agents, salicylates, NSAIDs, vitamin K antagonists, dextran, activated protein C). Decreased anticoagulant effect with glyceryl trinitrate infusion. Increased risk of hyperkalaemia with ACE inhibitors or angiotensin II antagonists.
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May increase prothrombin time. May cause false elevated T4 and T3 levels using an assay involving prolonged incubation.
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Description:
Mechanism of Action: Heparin is an anticoagulant. It increases the rate at which antithrombin III neutralises thrombin and activated factor Xa (including other coagulation factors IXa, Xa, XIa, XIIa, and plasmin). Additionally, it prevents the conversion of fibrinogen to fibrin, and stimulates the release of lipoprotein lipase.
Synonym(s): Unfractionated heparin.
Onset: Anticoagulation: Immediate (IV); approx 20-30 minutes (SC).
Pharmacokinetics:
Distribution: Volume of distribution: 36.6 ± 7.4 mL/kg. Plasma protein binding: Extensively bound after administration.
Excretion: Via urine (as metabolites; up to 50% as unchanged drug after large doses). Elimination half-life: 1-6 hours.
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Store below 30°C. Do not freeze. Avoid excessive heat. Protect from light.
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Anon. Heparin (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/06/2023. Anon. Heparin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 05/06/2023. Anon. Heparin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 05/06/2023. Buckingham R (ed). Heparin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/06/2023. Eprin Injection BP 1,000 IU/mL and 5,000 IU/mL, 5 mL Vial (Unimed Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 05/06/2023. Heparin (Mucous) Injection BP (Leo Laboratories Limited). MHRA. https://products.mhra.gov.uk. Accessed 05/06/2023. Heparin Sodium 10 IU/mL IV Flush Solution (Kent Pharma UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 05/06/2023. Heparin Sodium 100 IU/mL IV Flush Solution (Kent Pharma UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 07/08/2023. Heparin Sodium Injection, Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/06/2023. Heparin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 05/06/2023. Joint Formulary Committee. Heparin (Unfractionated). British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/06/2023. Paediatric Formulary Committee. Heparin (Unfractionated). BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 05/06/2023. Pfizer New Zealand Limited. DBL Heparin Sodium Injection BP Solution for Injection, 1,000 IU/mL and 25,000 IU/mL data sheet 24 December 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 05/06/2023.
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