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

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