Heparin

Heparin Brand Names

Hepflush-10 | Hep-Lock | Hep-Lock U/P | Monoject Prefill Advanced Heparin Lock Flush | SASH Normal Saline and Heparin

What is Heparin

Heparin is a parenteral anticoagulant widely used in clinical medicine. It is a glycosaminoglycan composed of chains of alternating residues of D-glucosamine and an uronic acid; its molecular weight ranges from 5,000—30,000 daltons, with a mean of 15,000 daltons (about 50 monosaccharide chains).

Commercially, heparin is derived from porcine or bovine tissue, and is available as the calcium or sodium salt.

Full therapeutic doses of heparin prolong clotting time; however, bleeding time is usually unaffected by heparin. The response to heparin is variable since only about one-third of the molecules have anticoagulant activity, and its activity and clearance is dependent upon the length and size of the heparin molecules.

The preferential clearance of larger molecules in vivo leads to accumulation of lower-molecular weight species that have a reduced ratio of antithrombin to antifactor Xa activity.

Compared with low molecular weight heparins, unfractionated heparin produces a less predictable anticoagulant response due primarily to its reduced bioavailability after subcutaneous administration of low doses, its dose-dependent clearance, and differences among patients in the nonspecific binding of heparin to proteins and cells.

Heparin was discovered in 1916 and was approved by the FDA in 1939.

Indications

1. acute myocardial infarction
2. antiphospholipid antibody syndrome
3. arterial thromboembolism
4. arterial thromboembolism prophylaxis
5. cerebral thromboembolism
6. coronary artery thrombosis prophylaxis
7. deep venous thrombosis (DVT)
8. deep venous thrombosis (DVT) prophylaxis
9. disseminated intravascular coagulation (DIC)
10. intravascular catheter occlusion prophylaxis
11. mural thrombosis
12. mural thrombosis prophylaxis
13. percutaneous coronary intervention (PCI)
14. periprocedural anticoagulation
15. prosthetic heart valves
16. pulmonary embolism
17. pulmonary embolism prophylaxis
18. thrombosis prophylaxis
19. unstable angina

Side Effects

1. adrenocortical insufficiency
2. alopecia
3. anaphylactic shock
4. anaphylactoid reactions
5. anemia
6. bleeding
7. bone fractures
8. bronchospasm
9. chills
10. elevated hepatic enzymes
11. epistaxis
12. erythema
13. fever
14. GI bleeding
15. headache
16. hematemesis
17. hematoma
18. hematuria
19. hyperkalemia
20. hyperlipidemia
21. hyphema
22. hypoaldosteronism
23. injection site reaction
24. intracranial bleeding
25. lacrimation
26. melena
27. myocardial infarction
28. nausea
29. ocular hemorrhage
30. osteoporosis
31. petechiae
32. priapism
33. prolonged bleeding time
34. pruritus
35. pulmonary embolism
36. purpura
37. retroperitoneal bleeding
38. rhinitis
39. skin necrosis
40. skin ulcer
41. stroke
42. subdural hematoma
43. thrombocytopenia
44. thromboembolism
45. thrombosis
46. urticaria
47. vaginal bleeding
48. vitamin D deficiency
49. vomiting

Monitoring Parameters

• hemoglobin/hematocrit
• partial thromboplastin time (PTT)
• platelet count

Contraindications

• aneurysm
• asthma
• benzyl alcohol hypersensitivity
• bleeding
• breast-feeding
• coagulopathy
• corn hypersensitivity
• disseminated intravascular coagulation (DIC)
• diverticulitis
• endocarditis
• fever
• geriatric
• head trauma
• hemophilia
• heparin hypersensitivity
• heparin-induced thrombocytopenia (HIT)
• hepatic disease
• hypertension
• hypotension
• infants
• infection
• inflammatory bowel disease
• intracranial bleeding
• intramuscular administration
• intramuscular injections
• lumbar puncture
• menstruation
• myocardial infarction
• neonates
• neoplastic disease
• peptic ulcer disease
• porcine protein hypersensitivity
• pregnancy
• premature neonates
• renal disease
• spinal anesthesia
• sulfite hypersensitivity
• surgery
• thrombocytopenia
• thrombophlebitis
• vaginal bleeding

Interactions

• Abciximab
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