• Prophylaxis and treatment of various thromboembolic disorders, including:
  • Deep vein thrombosis (DVT),
  • Pulmonary embolism (PE),
  • Atrial fibrillation with embolization,
  • Acute and chronic consumptive coagulopathies,
  • Peripheral arterial thromboembolism.
• Used in very low doses (10–100 units) to maintain patency of IV catheters (heparin flush).

Contraindicated in:

• Hypersensitivity
• Uncontrolled bleeding
• History of heparin-induced thrombocytopenia (HIT)
• Severe thrombocytopenia
• Pedi: Avoid use of products containing benzyl alcohol in premature infants.

Use Cautiously in:

• Severe renal impairment
• Severe hepatic impairment
• Retinopathy (hypertensive or diabetic)
• Ulcer disease
• Spinal cord or brain injury
• History of congenital or acquired bleeding disorder
• Malignancy
• Diabetes mellitus, chronic renal failure, metabolic acidosis, increased serum potassium, or concurrent use of potassium-sparing drugs (↑ risk of hyperkalemia)
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk; avoid use of products containing benzyl alcohol
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant; avoid use of products containing benzyl alcohol
• Geri: Women >60 yr have ↑ risk of bleeding.

Exercise Extreme Caution in:

• Severe uncontrolled hypertension
• Bacterial endocarditis, bleeding disorders
• GI bleeding/ulceration/pathology
• Hemorrhagic stroke
• History of thrombocytopenia related to heparin
• Recent CNS or ophthalmologic surgery
• Active GI bleeding/ulceration.

Derm: alopecia (long-term use), rash, urticaria.

F and E: hyperkalemia.

GI: ↑liver enzymes.

Hemat: anemia, BLEEDING, HIT (WITH OR WITHOUT THROMBOSIS).

Local: pain at injection site.

MS: osteoporosis (long-term use).
Misc: fever, hypersensitivity reactions.

Heparin is frequently used concurrently or sequentially with other agents affecting coagulation. The risk of potentially serious interactions is greatest with full anticoagulation.

Drug-Drug:

• Risk of bleeding may be ↑ by concurrent use of drugs that affect platelet function, including aspirin, NSAIDs, clopidogrel, dipyridamole, some penicillins, eptifibatide, tirofiban, and dextran.
• Risk of bleeding may be ↑ by concurrent use of drugs that cause hypoprothrombinemia, including quinidine, cefotetan, and valproic acid.
• Concurrent use of thrombolytics↑ risk of bleeding.
• Heparins affect the prothrombin time used in assessing the response to warfarin.
• Digoxin, tetracyclines, nicotine, and antihistamines may ↓ anticoagulant effect of heparin.

Drug-Natural Products:

• ↑risk of bleeding with arnica, anise, chamomile, clove, dong quai, fever few, garlic, ginger, and Panax ginseng.

(Generic available)

• Premixed infusion: 1000 units/500 mL; 2000 units/1000 mL; 12,500 units/250 mL; 25,000 units in 250 and 500 mL;
• Solution for injection: 10 units/mL; 100 units/mL; 1000 units/mL; 5000 units/mL; 7500 units/mL; 10,000 units/mL; 20,000 units/mL; 40,000 units/mL;

Therapeutic Anticoagulation

• IV (Adults): Intermittent bolus: 10,000 units, followed by 5000–10,000 units every 4–6 hr. Continuous infusion: 5000 units (35–70 units/kg), followed by 20,000–40,000 units infused over 24 hr (approx. 1000 units/hr or 15–18 units/kg/hr).
• IV (Children >1 yr): Intermittent bolus: 50–100 units/kg, followed by 50–100 units/kg every 4 hr. Continuous infusion: Loading dose 75 units/kg, followed by 20 units/kg/hr, adjust to maintain activated partial thromboplastin time (aPTT) of 60–85 sec.
• IV (Neonates and Infants <1 yr): Continuous infusion: Loading dose 75 units/kg, followed by 28 units/kg/hr, adjust to maintain aPTT of 60–85 sec.
• SC (Adults): 5000 units IV, followed by initial SUBQ dose of 10,000–20,000 units, then 8000–10,000 units every 8 hr or 15,000–20,000 units every 12 hr.

Prophylaxis of Thromboembolism

• SC (Adults): 5000 units every 8–12 hr (may be started 2 hr prior to surgery).

Cardiovascular Surgery

• IV (Adults): At least 150 units/kg (300 units/kg if procedure <60 min; 400 units/kg if >60 min).
• IA (Neonates , Infants, and Children): 100–150 units/kg via an artery prior to cardiac catheterization.

Line Flushing

• IV (Adults and Children): 10–100 units/mL (10 units/mL for infants <10 kg, 100 units/mL for all others) solution to fill heparin lock set to needle hub; replace after each use.

Total Parenteral Nutrition

• IV (Adults and Children): 0.5–1 units/mL (final solution concentration) to maintain line patency.

Arterial Line Patency

• IA (Neonates): 0.5–2 units/mL.

• Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin.
• In low doses, prevents the conversion of prothrombin to thrombin by its effects on factor Xa.
• Higher doses neutralize thrombin, preventing the conversion of fibrinogen to fibrin.

• Prevention of thrombus formation.
• Prevention of extension of existing thrombi (full dose).

Therapeutic Classification: anticoagulants

Pharmacologic Classification: antithrombotics

Absorption: Erratically absorbed following SUBQ or IM administration. IV administration results in complete bioavailability.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Probably removed by the reticuloendothelial system (lymph nodes, spleen).

Half-life: 1–2 hr (↑ with increasing dose); affected by obesity, renal and hepatic function, malignancy, presence of PE, and infections.

(anticoagulant effect)

• Explain purpose of heparin to patient.
• Advise patient to report any symptoms of unusual bleeding or bruising to health care professional immediately.
  • Instruct patient not to take medications containing aspirin or NSAIDs while on heparin therapy.
• Caution patient to avoid IM injections and activities leading to injury and to use a soft toothbrush and electric razor during heparin therapy.
  • Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
  • Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

HEP-a-rin