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Heparin calcium
Heparin calcium Calcilean
Heparin
(HEP-ah-rin)
Pregnancy Category: C
Heparin sodium injection
Heparin sodium injection (Liquaemin Sodium)
Heparin
(HEP-ah-rin)
Pregnancy Category: C Hepalean Hepalean-Lok Heparin Leo (Rx)
Heparin sodium and sodium chloride
Heparin sodium and sodium chloride Heparin Sodium and 0.45% Sodium Chloride
Heparin
(HEP-ah-rin)
Pregnancy Category: C Heparin Sodium and 0.45% Sodium Chloride Heparin Sodium and 0.9% Sodium Chloride (Rx)
Heparin sodium lock flush solution
Heparin sodium lock flush solution (Heparin lock flush, Hep-Lock)
Heparin
(HEP-ah-rin)
Pregnancy Category: C Heparin lock flush Hep-Lock Hep-Lock U/P (Rx)

Classification: Anticoagulant

Action/Kinetics: Anticoagulants do not dissolve previously formed clots, but they do forestall their enlargement and prevent new clots from forming. Heparin potentiates the inhibitory action of antithrombin III on various coagulation factors including factors IIa, IXa, Xa, XIa, and XIIa. This occurs due to the formation of a complex with and causing a conformational change in the antithrombin III molecule. Inhibition of factor Xa results in interference with thrombin generation; thus, the action of thrombin in coagulation is inhibited. Heparin also increases the rate of formation of antithrombin III-thrombin complex causing inactivation of thrombin and preventing the conversion of fibrinogen to fibrin. By inhibiting the activation of fibrin-stabilizing factor by thrombin, heparin also prevents formation of a stable fibrin clot. Therapeutic doses of heparin prolong thrombin time, whole blood clotting time, activated clotting time, and PTT. Heparin also decreases the levels of triglycerides by releasing lipoprotein lipase from tissues; the resultant hydrolysis of triglycerides causes increased blood levels of free fatty acids. Onset: IV, immediate; deep SC: 20-60 min. Peak plasma levels, after SC: 2-4 hr. t1/2: 30-180 min in healthy persons. t1/2 increases with dose, severe renal disease, and cirrhosis and in anephric clients and decreases with pulmonary embolism and liver impairment other than cirrhosis. Metabolism: Probably by reticuloendothelial system although up to 50% is excreted unchanged in the urine. Clotting time returns to normal within 2-6 hr.

Uses: Pulmonary embolism, peripheral arterial embolism, prophylaxis, and treatment of venous thrombosis and its extension. Atrial fibrillation with embolization. Diagnosis and treatment of disseminated intravascular coagulation. Low doses to prevent deep venous thrombosis and pulmonary embolism in pregnant clients with a history of thromboembolism, urology clients over 40 years of age, clients with stroke or heart failure, AMI or pulmonary infection, high-risk surgery clients, moderate and high-risk gynecologic clients with no malignancy, neurology clients with extracranial problems, and clients with severe musculoskeletal trauma. Prophylaxis of clotting in blood transfusions, extracorporeal circulation, dialysis procedures, blood samples for lab tests, and arterial and heart surgery. Investigational: Prophylaxis of post-MI, CVAs, and LV thrombi. By continuous infusion to treat myocardial ischemia in unstable angina refractory to usual treatment. Adjunct to treat coronary occlusion with AMI. Prophylaxis of cerebral thrombosis in evolving stroke.
Heparin lock flush solution: Dilute solutions are used to maintain patency of indwelling catheters used for IV therapy or blood sampling. Not to be used therapeutically.

Contraindications: Active bleeding, blood dyscrasias (or other disorders characterized by bleeding tendencies such as hemophilia), clients with frail or weakened blood vessels, purpura, thrombocytopenia, liver disease with hypoprothrombinemia, suspected intracranial hemorrhage, suppurative thrombophlebitis, inaccessible ulcerative lesions (especially of the GI tract), open wounds, extensive denudation of the skin, and increased capillary permeability (as in ascorbic acid deficiency). IM use.
Do not administer during surgery of the eye, brain, or spinal cord or during continuous tube drainage of the stomach or small intestine. Use is also contraindicated in subacute endocarditis, shock, threatened abortion, severe hypertension, diverticulitis, colitis, SBE, or hypersensitivity to drug. Premature neonates due to the possibility of a fatal ``gasping syndrome.'' Also, regional anesthesia and lumbar block, vitamin K deficiency, leukemia with bleeding tendencies, open wounds or ulcerations, acute nephritis, impaired hepatic or renal function, or severe hypertension. In the presence of drainage tubes in any orifice. Alcoholism.

Special Concerns: Use with caution in menstruation, in pregnant women (because they may cause hypoprothrombinemia in the infant), during lactation, during the postpartum period, and following cerebrovascular accidents. Geriatric clients may be more susceptible to developing bleeding complications, unusual hair loss, and itching.

Side Effects: CV: Hemorrhage ranging from minor local ecchymoses to major hemorrhagic complications from any organ or tissue. Higher incidence is seen in women over 60 years of age. Hemorrhagic reactions are more likely to occur in prophylactic administration during surgery than in the treatment of thromboembolic disease. White clot syndrome. Hematologic: Thrombocytopenia (both early and late). Hypersensitivity: Chills, fever, urticaria are the most common. Rarely, asthma, lacrimation, headache, N&V;, rhinitis, shock, anaphylaxis. Allergic vasospastic reaction within 6-10 days after initiation of therapy (lasts 4-6 hr) including painful, ischemic, cyanotic limbs. Use a test dose of 1,000 units in clients with a history of asthma or allergic disease. Miscellaneous: Hyperkalemia, cutaneous necrosis, osteoporosis (after long-term high doses), delayed transient alopecia, priapism, suppressed aldosterone synthesis. Discontinuance of heparin has resulted in rebound hyperlipemia. Following IM (usual), SC: Local irritation, erythema, mild pain, ulceration, hematoma, and tissue sloughing.

Laboratory Test Alterations: AST and ALT.

Overdose Management: Symptoms: Nosebleeds, hematuria, tarry stools, petechiae, and easy bruising may be the first signs. Treatment: Drug withdrawal is usually sufficient to correct heparin overdosage. Protamine sulfate (1%) solution; each mg of protamine neutralizes about 100 USP heparin units.

Drug Interactions: Alteplase, recombinant / Risk of bleeding, especially at arterial puncture sites Anticoagulants, oral / Additive PT Antihistamines / Effect of heparin Aspirin / Additive PT Bromelain / Tendency for bleeding Cephalosporins / Risk of bleeding R/T additive effect Cinchona bark / Anticoagulant effect Dextran / Additive PT Digitalis / Effect of heparin Dipyridamole / Additive PT Feverfew / Possible additive antiplatelet effect Ginger / Possible additive antiplatelet effect Ginkgo biloba / Effect on blood coagulation Ginseng / Potential for effect on platelet aggregation Goldenseal / Antagonizes action of heparin Hydroxychloroquine / Additive PT Ibuprofen / Additive PT Indomethacin / Additive PT Insulin / Heparin antagonizes insulin effect Nicotine / Effect of heparin Nitroglycerin / Effect of heparin NSAIDs / Additive PT Penicillins / Risk of bleeding R/T possible additive effects Salicylates / Risk of bleeding Streptokinase / Relative resistance to effects of heparin Tetracyclines / Effect of heparin Ticlopidine / Additive PT

How Supplied: Heparin sodium injection: Injection: 1,000 U/mL, 2,000 U/mL, 2,500 U/mL, 5,000 U/mL, 7,500 U/mL, 10,000 U/mL, 20,000 U/mL. Heparin sodium and sodium chloride: Injection: 200 U/100 mL-0.9%, 5,000 U/100 mL-0.45%, 10,000 U/100 mL-0.45%; Pack: 10U/mL-0.9%, 100 U/mL-0.9%. Heparin sodium lock flush solution: Kit: 10 U/mL, 100 U/mL

Dosage
NOTE: Adjusted for each client on the basis of laboratory tests. •Deep SC General heparin dosage.
Initial loading dose: 10,000-20,000 units; maintenance: 8,000-10,000 units q 8 hr or 15,000-20,000 units q 12 hr. Use concentrated solution.
Prophylaxis of postoperative thromboembolism.
5,000 units of concentrated solution 2 hr before surgery and 5,000 units q 8-12 hr thereafter for 7 days or until client is ambulatory.
•Intermittent IV General heparin dosage.
Initial loading dose: 10,000 units undiluted or in 50-100 mL saline; then, 5,000-10,000 units q 4-6 hr undiluted or in 50-100 mL saline.
•Continuous IV Infusion General heparin dosage.
Initial loading dose: 20,000-40,000 units/day in 1,000 mL saline (preceded initially by 5,000 units IV).
•Special Uses Surgery of heart and blood vessels.
Initial, 150-400 units/kg to clients undergoing total body perfusion for open heart surgery. NOTE: 300 units/kg may be used for procedures less than 60 min while 400 units/kg is used for procedures lasting more than 60 min. To prevent clotting in the tube system, add heparin to fluids in pump oxygenator.
Extracorporeal renal dialysis.
See instructions on equipment.
Blood transfusion.
400-600 units/100 mL whole blood. 7,500 units should be added to 100 mL 0.9% sodium chloride injection; from this dilution, add 6-8 mL/100 mL whole blood.
Laboratory samples.
70-150 units/10- to 20-mL sample to prevent coagulation.
Heparin lock sets.
To prevent clot formation in a heparin lock set, inject 10-100 units/mL heparin solution through the injection hub in a sufficient quantity to fill the entire set to the needle tip.