Heparin Sodium

Introduction: Heparin Sodium is an anticoagulant which prevents abnormal clotting of blood. It not only prevents the formation of harmful blood clots in the legs, lungs, and heart but also stops them from growing bigger.

How it works: Heparin increases the inhibitory action of antithrombin III (AT III) on clotting factors XIIa, XIa, IXa, Xa and thrombin. This inhibits the conversion of prothrombin to thrombin and fibrinogen to fibrin. It also inhibits platelet function.

Important Information: This medicine is administered under the supervision of a doctor. Regular blood tests are required (platelet count, hematocrit). It increases the risk of bleeding - inform your doctor if you see signs of bleeding.

• Prophylaxis and treatment of venous thromboembolism and pulmonary embolism
• Atrial fibrillation with embolization
• Acute and chronic consumptive coagulopathies (disseminated intravascular coagulation)
• Prevention of clotting in arterial and cardiac surgery
• Prophylaxis and treatment of peripheral arterial embolism
• Anticoagulant use in blood transfusions, extracorporeal circulation, dialysis procedures and catheter patency

Parenteral anti-coagulants

Anticoagulant

Heparin inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both in vitro and in vivo. Heparin acts at multiple sites in the normal coagulation system. Small amounts of heparin in combination with Antithrombin III (heparin cofactor) can inhibit thrombosis by inactivating activated Factor X and inhibiting the conversion of prothrombin to thrombin. Once active thrombosis has developed, larger amounts of heparin can inhibit further coagulation by inactivating thrombin and preventing conversion of fibrinogen to fibrin.

Heparin binds to antithrombin III to inhibit clotting factor activity, thereby preventing blood clotting.

Therapeutic Anticoagulant Effect (Full-Dose Heparin):

Deep Subcutaneous (Intrafat) Injection:

• Initial Dose: 333 units/kg
• Every 12 hours: 250 units/kg

Intermittent Intravenous Injection:

• Initial Dose: 10,000 units
• Every 4-6 hours: 5,000-10,000 units

Continuous Intravenous Infusion:

• Initial Dose: 5,000 units (IV injection)
• Continuous: 20,000-40,000 units/24 hours

Heart and Blood Vessel Surgery:

• ≥ 150 units/kg

Catheter Patency Maintenance:

• 2 units/mL (infusion rate 3 mL/hour)

* Use as directed by the registered physician

Intravenous (IV) injection/infusion or deep subcutaneous (SC) injection. Do not use intramuscular (IM). Your doctor or nurse will give you this medicine. Do not self-administer.

If you miss a dose, consult your doctor.

Common Side Effects (>10%):

• Heparin-induced thrombocytopenia (10-30%)

Other Side Effects:

• Mild pain at injection site, hematoma, hemorrhage, local irritation, erythema
• Increased liver aminotransferase
• Anaphylaxis
• Immune hypersensitivity reaction
• Osteoporosis (long-term, high-dose use)

Serious (Potentially Fatal): HIT with or without thrombosis; bleeding

Precautions:

• Notify doctor if you see blood in urine or stool or any unusual bleeding
• Inform doctor if you experience rash, itching, swelling of face, tongue and throat
• Regular platelet counts, hematocrits and stool occult blood tests are recommended
• Caution in active bleeding, thrombocytopenia, peptic ulcer, cerebrovascular disorders, severe hypertension

Contraindications:

• Severe thrombocytopenia
• Uncontrollable active bleeding
• Bacterial endocarditis
• Severe hypertension
• Severe renal and hepatic impairment
• Cerebral or subarachnoid haemorrhage

Drug Interactions:

• Drugs affecting platelet function or coagulation system (platelet aggregation inhibitors, thrombolytic agents, salicylates, NSAIDs, vitamin K antagonists) enhance anticoagulant effect
• Glyceryl trinitrate infusion decreases anticoagulant effect
• Increased risk of hyperkalemia with ACE inhibitors or angiotensin II antagonists

Food Interactions:

• Unsafe to consume alcohol with Heparin Sodium

Use in Pregnancy: Pregnancy Category C. Heparin does not cross the placental barrier. Use only if clearly needed.

Use in Lactation: Safe during breastfeeding. Small amounts are excreted in breast milk but not harmful to the baby.

Pediatric Use: Safety and effectiveness in pediatric patients have not been established.

Geriatric Use: Elderly patients have higher risk of bleeding - use with caution.

Renal Impairment: Safe in kidney disease (no dose adjustment needed), but caution in severe kidney disease.

Hepatic Impairment: Limited information available. Consult your doctor.

Overdose: Bleeding is the chief sign. Protamine sulfate (1% solution) by slow infusion will neutralize heparin. Each mg of protamine sulfate neutralizes approximately 100 BP heparin units.

Storage: Do not store above 30°C. Keep away from light and out of reach of children.

Heparin Sodium