Adult Dosing

Therapeutic anticoagulation

Deep Subcutaneous

• Initial Dose: 5000 units IV, followed by 10,000-20,000 units SC
• Maintenance Dose: 8000-10,000 units SC q8 hrs; Alt: 15,000-20,000 units SC q12 hrs

Intermittent IV injection

• Initial Dose: 10,000 units IV
• Maintenance Dose: 5000-10,000 units IV q4-6 hrs

Continuous IV infusion

• Initial Dose: 5000 units IV
• Continuous dose: 20,000-40,000 units/24 hrs diluted in 1000 mL of 0.9% Sodium Chloride Injection, (or in any compatible solution)

Cardiovascular surgery

• Initial dose: 150 units/kg
• Followed by 300 units/kg if procedure <60 mins and 400 units/kg if procedure >60 mins

Thromboembolism, postoperative prophylaxis

• 5000 units SC 2 hrs before surgery, followed by 5000 units SC q8-12 hrs x 7 days or until the patient is ambulatory

Blood transfusions

• Add 400-600 units/100 mL of whole blood

Laboratory Samples

• 70-150 units/10-25 mL sample of whole blood to prevent coagulation of the sample
• Do not use for isoagglutinin, complement, or erythrocyte fragility tests or platelet counts

• Avoid intramuscular route of administration because of frequent occurrence of hematoma at the injection site
• When given by continuous intravenous infusion, determine the coagulation time approximately every 4 hrs in the early stages of treatment, when administered intermittently by intravenous injection perform coagulation tests before each injection during the early stages of treatment and at appropriate intervals thereafter and after deep subcutaneous injections perform test 4-6 hrs after the injection

Pulmonary embolism [Non-FDA Approved]

• 60-80 U/kg IV bolus over 10 min then initiate an infusion of 12-18 U/kg/hr

Acute Coronary Syndromes [Non-FDA Approved]

• 60 units/kg IV bolus followed by 12 units/kg/hr infusion
• Frequent monitoring of APTT (q6 hrs until 2 consecutive values between 50-70 secs), continue for total 48 hrs

Pediatric Dosing

Therapeutic anticoagulation

• Initial dose: 50 units/kg IV infusion
• Maintenance dosing: 100 units/kg IV infusion q4 hrs; Alt: 20,000 units/m²/24 hrs continuously

Note:

• Do not administer heparin sodium injection, preserved with benzyl alcohol, to neonates and infants

Pulmonary embolism [Non-FDA Approved]

• 50-80 U/kg IV bolus over 10 min then initiate an infusion of 18-28 U/kg /hr

[Outline]

• Adult Dosing
• Pediatric Dosing

• Prophylaxis and treatment of venous thrombosis and its extension
• Prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdominothoracic surgery
• Prophylaxis and treatment of pulmonary embolism
• Atrial fibrillation with embolization
• Diagnosis and treatment of acute and chronic consumptive coagulopathies
• Prevention of clotting in arterial and cardiac surgery
• Prophylaxis and treatment of peripheral arterial embolism
• As an anticoagulant in blood transfusions, extracorporeal circulation, dialysis procedures and in blood samples for laboratory purposes

• Hypersensitivity to any of the ingredients of the product
• Severe thrombocytopenia
• Patients in whom suitable blood coagulation tests cannot be performed
• Uncontrolled active bleeding, except DIC
• Products containing benzyl alcohol should not be used in neonates, infants, pregnant women, or nursing mothers

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Carefully examine heparin sodium injection vials to confirm the correct vial choice prior to administration of the drug and do not use heparin sodium injection vials as catheter lock flush product, as vials contains various strengths of heparin (1000-10000 units) in 1 mL and can lead to fatal hemorrhages due to medication errors
• Patients receiving heparin can develop hemorrhage at virtually any site. If there is unexplained fall in hematocrit, fall in blood pressure or any other unexplained symptom, consider serious hemorrhagic event. Exercise caution while using heparin in patients at high risk of hemorrhage like bleeding disorders, GI lesions, menstruation, severe hypertension, major surgery
• Regulate the heparin dosage by frequent blood coagulation tests, discontinue the therapy promptly if coagulation test is unduly prolonged or if hemorrhage occurs
• Incidence of thrombocytopenia has been reported in patients receiving heparin. Evaluate platelet count at baseline and periodically during therapy. Closely monitor if mild thrombocytopenia (platelet count >100,000/mm³) and discontinue the drug if count falls below 100,000/mm³ or if recurrent thrombosis develops and if necessary, an alternative anticoagulant should be administered
• Heparin induced thrombocytopenia (HIT) is a serious antibody-mediated reaction that can lead to the development of venous and arterial thromboses, a condition referred to as Heparin induced Thrombocytopenia and Thrombosis (HITT). This includes deep vein thrombosis, pulmonary embolism, cerebral vein thrombosis, limb ischemia, stroke, myocardial infarction, mesenteric thrombosis, renal arterial thrombosis, skin necrosis, gangrene of the extremities that may lead to amputation, and possibly death
• Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT and HITT, as HIT and HITT can occur up to several weeks after the discontinuation of heparin therapy
• Increased resistance to heparin is frequently reported in fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies, myocardial infarction, cancer and in postsurgical patients
• During the entire course of heparin therapy, periodic platelet counts, hematocrit, and tests for occult blood in stool are recommended

Cautions: Use cautiously in

• Liver diseases
• Severe hypertension
• Bacterial endocarditis
• Recent spinal tap
• Recent spinal anesthesia
• Recent major surgery
• Bleeding tendencies
• Spinal cord or brain injury
• Ulcerative lesions
• Menstruation
• History of GI bleed

Pregnancy Category:C

Breastfeeding: Generally considered as safe. Low molecular weight heparins are not excreted into breastmilk in significant amounts. Since heparin has an even higher molecular weight, it would not be expected to be excreted in breastmilk or absorbed by the infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 15 March 2011). As per manufacturer's data, heparin is not excreted in human milk hence preservative free heparin sodium injection can be administered to nursing mothers.

• GI: Nausea, vomiting, elevations of aminotransferase
• CNS: Headache
• HEMA: Hemorrhage including adrenal hemorrhage, prolonged clotting time, thrombocytopenia, HIT, HITT
• GU: Ovarian hemorrhage, priapism
• RESP: Asthma, rhinitis
• MUSC: Painful, ischemic and cyanosed limbs, osteoporosis
• DERM: Cutaneous necrosis, alopecia
• LOCAL: Local irritation, erythema, mild pain, hematoma, ulceration
• HYPERSENSITIVITY: Hypersensitivity reactions, anaphylactoid reactions, chills, fever, urticaria, itching and burning on the plantar side of the feet

• Anticoagulant; in combination with antithrombin III, inhibits thrombosis by inactivating activated Factor X and inhibiting the conversion of prothrombin to thrombin
• Metabolized by Liver and the reticulo-endothelial system
• Renally excreted
• Half-life: 1.5 hrs

US Trade Name(s)

• Heparin Lock Flush

US Availability

heparin (generic)

• INJ: 1000 U/mL (1, 10, 30 mL vials)
• INJ: 5000 U/mL (1 mL vial)
• INJ: 10,000 U/mL (1, 5 mL vial)
• INJ: 20,000 U/mL (1 mL vial)
• INJ in 0.9% Sodium Chloride: 200 U/100 mL
• INJ in 0.9% Sodium Chloride: 5000 U/100 mL
• INJ in 0.9% Sodium Chloride: 10,000 U/100 mL
• INJ in 0.45% Sodium Chloride: 200 U/100 mL
• INJ in 0.45% Sodium Chloride: 5000 U/100 mL
• INJ in 0.45% Sodium Chloride: 10,000 U/100 mL
• INJ in 5% Dextrose: 4,000 U/100 mL
• INJ in 5% Dextrose: 10,000 U/100mL
• INJ in 5% Dextrose: 5,000 U/100mL
• INJ in 5% Dextrose: 10,000 U/100mL

Heparin Lock Flush

• INJ: 100 U/mL

Canadian Trade Name(s)

• Hepalean
• Hepalean-LOK

Canadian Availability

heparin (generic)

• INJ: 100 U/mL
• INJ: 1000 U/mL
• INJ: 10,000 U/mL
• INJ: 25,000 U/mL
• INJ in 0.9% Sodium Chloride: 2 U/mL
• INJ in 0.9% Sodium Chloride: 1000 U/100 mL
• INJ in 0.5% Dextrose: 40 U/mL
• INJ in 0.5% Dextrose: 4000 U/100mL
• INJ in 0.5% Dextrose: 5000 U/100mL
• INJ in 0.5% Dextrose: 10,000 U/100mL

heparin Lock Flush

• INJ: 10 U/mL
• INJ: 100 U/mL

Hepalean

• INJ: 100 U/mL
• INJ: 1000 U/mL (1, 10, 30 mL vials)
• INJ: 10,000 U/mL (1, 5 mL vial)
• INJ: 25,000 U/mL (2 mL vial)

Hepalean-LOK

• INJ: 10 U/mL (10 mL vials)
• INJ: 100 U/mL (1, 10 mL vials)

UK Trade Name(s)

• Hepsal

UK Availability

heparin sodium (generic)

• INJ: 10 U/mL (2 mL amp)
• INJ: 100 U/mL (2 mL amp)
• INJ: 1000 U/mL (5 mL vial
• INJ: 1000 U/mL (5, 10, 20 mL amp)
• INJ: 5,000 U/mL (5 mL vial)
• INJ: 25,000 U/mL (5 mL vial)

heparin calcium (generic)

• INJ: 5,000 U/mL

Hepsal

• INJ: 10 U/mL (5 mL amp)

Australian Trade Name(s)

• Heparinised Saline Injection

Australian Availability

heparin sodium (generic)

• INJ: 1000 U/mL
• INJ: 5000 U/0.2 mL
• INJ: 5000 U/mL
• INJ: 5000 U/5 mL
• INJ: 25000 U/5 mL
• INJ: 35000 U/35 mL

Heparinised Saline Injection

• INJ: 50 U/5 mL

[Outline]

Hematology/Oncology

Anticoagulants

Heparins

Cardiovascular

Anticoagulants

Heparins

Cardiovascular

Anticoagulants

Antithrombotics