Calcilean, Calciparine, Hepalean, Heparin Leo, Hep-Lock, Hep-Lock U/P
Prophylaxis and treatment of various thromboembolic disorders, including Venous thromboembolism, pulmonary emboli, 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).
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. Therapeutic Effects: Prevention of thrombus formation. Prevention of extension of existing thrombi (full dose).
Adverse Reactions/Side Effects
GI: drug-induced hepatitis. Derm: alopecia (long-term use), rashes, urticaria. Hemat: BLEEDING, anemia, thrombocytopenia (can occur up to several weeks after discontinuation of therapy). Local: pain at injection site. MS: osteoporosis (long-term use). Misc: fever, hypersensitivity.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Monitor symptoms of deep vein thrombosis (DVT) (pain, swelling, warmth, redness) to determine if drug therapy is effective in preventing or reducing venous thrombosis. Request or administer objective tests (Doppler ultrasound) if symptoms increase.
In patients with DVT, watch for signs of pulmonary embolism, such as shortness of breath, chest pain, cough, and bloody sputum. Notify physician or nursing staff immediately if these signs occur.
Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if heparin causes excessive anticoagulation.
Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Be alert for acute arterial or venous thrombosis caused by heparin-induced thrombocytopenia (HIT). In certain patients, heparin initiates an immune reaction where antibodies attack circulating platelets. Although most cases of HIT are minor and asymptomatic, some patients may experience life- or limb-threatening platelet clots, resulting in myocardial infarction, ischemic stroke, acute leg ischemia, or venous thromboembolism. HIT can occur during and up to several weeks after heparin therapy. Any signs of increased clotting should be reported immediately.
Watch for unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.
Monitor and report signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flulike symptoms, and muscle/joint pain.
Assess injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician or nursing staff.
Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.
Recommend or implement other physical methods to decrease DVT and prevent thromboembolism, including graduated compression stockings and intermittent pneumatic compression pumps.
Implement early mobilization and ambulation to reduce the risk of new or increased DVT. Early ambulation appears to be safe in patients with DVT if the patient is adequately heparinized (INR values in acceptable range), does not have an active pulmonary embolism, or have other risk factors that contraindicate ambulation.
Institute weight-bearing and resistance exercises during long-term heparin use to maintain or increase bone mineral density and prevent osteoporosis.
Instruct patient immediately to report signs of GI bleeding, including abdominal pain, vomiting blood, blood in stools, or black, tarry stools.
Absorption: Erratically absorbed following SC or IM administration.
Distribution: Does not cross the placenta or enter breast milk.
Protein Binding: Very high (to low-density lipoproteins, globulins, and fibrinogen).
Metabolism and Excretion: Probably removed by the reticuloendothelial system (lymph nodes, spleen).
Half-life: 1–2 hr (increases with increasing dose); affected by obesity, renal and hepatic function, malignancy, presence of pulmonary embolism, and infections.
TIME/ACTION PROFILE (anticoagulant effect)
|ROUTE ||ONSET ||PEAK ||DURATION |
|Heparin SC ||20–60 min ||2 hr ||8–12 hr |
|Heparin IV ||immediate ||5–10 min ||2–6 hr |
Contraindicated in: Hypersensitivity; Uncontrolled bleeding; Severe thrombocytopenia; Open wounds (full dose); Products containing benzyl alcohol should not be used in premature infants.
Use Cautiously in: Severe liver or kidney disease; Retinopathy (hypertensive or diabetic); Untreated hypertension; Ulcer disease; Spinal cord or brain injury; History of congenital or acquired bleeding disorder; Malignancy; OB: May be used during pregnancy, but use with caution during the last trimester and in the immediate postpartum period; Geri: Women >60 yr have increased risk of bleeding.
Exercise Extreme Caution in: Severe uncontrolled hypertension; Bacterial endocarditis, bleeding disorders; GI bleeding/ulceration/pathology; Hemorrhagic stroke; Recent CNS or ophthalmologic surgery; Active GI bleeding/ulceration; History of thrombocytopenia related to heparin.
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, ticlopidine, abciximab, eptifibatide, tirofiban, and dextran. Risk of bleeding may be ↑ by concurrent use of drugs that cause hypoprothrombinemia, including quinidine, cefoperazone, 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. Streptokinase may be followed by relative resistance to heparin.
Drug-Natural: ↑ risk of bleeding with arnica, anise, chamomile, clove, dong quai, fever few, garlic, ginger, and Panax ginseng.
IV (Adults): Intermittent bolus—10,000 units, followed by 5000–10,000 units q 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 q 4 hr. Continuous infusion—Loading dose 75 units/kg, followed by 20 units/kg/hr, adjust to maintain 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 a PTT of 60–85 sec.
Subcut (Adults): 5000 units IV, followed by initial SC dose of 10,000–20,000 units, then 8000–10,000 units q 8 hr or 15,000–20,000 units q 12 hr.
Prophylaxis of Thromboembolism
SC (Adults): 5000 units q 8–12 hr (may be started 2 hr prior to 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.
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): 05–1 units/mL (final solution concentration) to maintain line patency.
IA (Neonates): 0.5–2 units/mL.
Availability (generic available)
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. Premixed solution: 1000 units/500 mL, 2000 units/1000 mL, 12,500 units/250 mL, 25,000 units in 250 and 500 mL.