IntravenousProphylaxis of re-occlusion of the coronary arteries following thrombolytic therapy in myocardial infarctionAdult: 60 U/kg (max: 4,000 U) or a bolus of 5,000 U if streptokinase was used, followed by 12 U/kg/hr (max: 1,000 U/hr) w/ a treatment duration of 48 hr.
IntravenousPeripheral arterial embolism, Unstable angina, Venous thromboembolismAdult: 75-80 U/kg or 5,000 U (10,000 U in severe pulmonary embolism) IV loading dose followed by 18 U/kg or 1,000-2,000 U/hr continuous infusion. Alternatively, intermittent inj of 5,000-10,000 U 4-6 hrly.
Child: 50 U/kg loading dose, followed by an infusion of 15-25 U/kg/hr.
Elderly: Lower dosages may be required.
SubcutaneousProphylaxis of postoperative venous thromboembolismAdult: 5,000 U given 2 hr before surgery then 8-12 hrly for 7 days or until the patient is ambulant.
SubcutaneousVenous thromboembolismAdult: 15,000-20,000 U 12 hrly or 8,000-10,000 U 8 hrly.
Child: 250 U/kg bid.
Elderly: Lower dosages may be required.
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Alteplase, reteplase, amikacin sulfate, amiodarone HCl, ampicillin Na, aprotinin, benzylpenicillin K or Na, cefalotin Na, ciprofloxacin lactate, cytarabine, dacarbazine, daunorubicin HCl, diazepam, dobutamine HCl, doxorubicin HCl, droperidol, erythromycin lactobionate, gentamicin sulfate, haloperidol lactate, hyaluronidase, hydrocortisone Na succinate, kanamycin sulfate, meticillin Na, netilmicin sulfate, some opioid analgesics, oxytetracycline HCl, some phenothiazines, polymyxin B sulfate, streptomycin sulfate, tetracycline HCl, tobramycin sulfate, vancomycin HCl, vinblastine sulfate, cisatracurium besilate, labetalol HCl, levofloxacin, nicardipine HCl, vinorelbine tartrate, and cefmetazole Na.
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Current or history of heparin-induced thrombocytopenia; generalised or local haemorrhagic tendency, including uncontrolled severe HTN, severe liver insufficiency, active peptic ulcer, acute or subacute septic endocarditis, intracranial haemorrhage or injuries and operations on the CNS, eyes and ears, and in women w/ abortus imminens; epidural anaesth during birth; locoregional anaesth in elective surgical procedures (in patients receiving heparin for treatment rather than prophylaxis).
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Patient w/ increased risk of bleeding complications, HTN, DM, pre-existing metabolic acidosis. Do not use in catheter lock flushing. Hepatic and renal impairment. Elderly. Pregnancy and lactation.
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Hypersensitivity reactions (e.g. chills, fever, urticaria, asthma, rhinitis); painful, ischaemic and cyanosed limbs; osteoporosis (in long-term admin), suppression of aldosterone synthesis leading to hyperkalaemia, cutaneous necrosis, delayed transient alopecia, priapism, rebound hyperlipaemia; increased serum concentrations of AST and ALT, prolonged prothrombin time; local irritation, erythema, mild pain, haematoma or ulceration on inj site.
Potentially Fatal: Heparin-induced thrombocytopenia w/ or w/out thrombosis, severe haemorrhage.
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Preservative-free formulation is recommended in neonates, infants, pregnant women and nursing mothers.
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Monitor Hb, haematocrit, signs of bleeding; faecal occult blood test; aPTT (or antifactor Xa activity levels) or activated clotting time (ACT) depending upon indication.
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Symptoms: Bleeding (nose bleeds, blood in urine or tarry stools may be noted as the 1st sign of bleeding). Management: May give protamine sulfate by slow IV infusion over 10 min to treat severe bleeding (1 mg of protamine sulfate neutralises approx 100 U of heparin). Max: 50 mg as a single dose.
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Enhanced anticoagulant effect w/ other drugs affecting platelet function or the coagulation system (e.g. platelet aggregation inhibitors, thrombolytic agents, salicylates, NSAIDs, vit K antagonists, dextrans, activated protein C). Decreased anticoagulant effect w/ gyceryl trinitrate infusion. Increased risk of hyperkalaemia w/ ACE inhibitors or angiotensin II antagonists.
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May interfere w/ sulfobromophthalein test. May cause falsely elevated results in the competitive binding methods for serum thyroxine determinations.
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Description: Heparin potentiates the action of antithrombin III, thereby inactivates thrombin as well as activated coagulation factors IX, X, XI, XII and plasmin, and inhibits the conversion of fibrinogen to fibrin. It also stimulates release of lipoprotein lipase which hydrolyses triglycerides to glycerol and free fatty acids.
Onset: Anticoagulation: Immediate (IV); approx 20-30 min (SC).
Pharmacokinetics:
Absorption: Absorbed from systemic circulation.
Distribution: Plasma protein binding: Extensive.
Metabolism: Partially metabolised in the liver to uroheparin (partially desulfated heparin); appears to be removed from the circulation mainly by the reticuloendothelial system and may localise on arterial venous endothelium.
Excretion: Via urine (as metabolites, or up to 50% as unchanged drug after admin of large doses). Half-life: 1-6 hr.
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Store between 20-25°C. Protect from freezing.
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Anon. Heparin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 13/08/2014. Buckingham R (ed). Heparin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/08/2014. Heparin Sodium Injection, Solution (Hospira, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 13/08/2014. Heparin Sodium Injection. U.S. FDA. https://www.fda.gov/. Accessed 13/08/2014. McEvoy GK, Snow EK, Miller J et al (eds). Heparin Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 13/08/2014.
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