Difference between revisions of "Unfractionated heparin"

m (Rossdonaldson1 moved page Heparin (Unfractionated) to Unfractionated Heparin)
(Adult Dosing)
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==Background==
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==General==
*Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
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*Type: Anticoagulant
*Anticoagulation effect lasts up to 3hr after stopping infusion
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*Dosage Forms: IV, SC
*Must give IV (not subq) for acute thromboembolic disease
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*Common Trade Names: Heparin
*Safe in pregnancy
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*Unpredictable anticoagulation effect
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==Adult Dosing==
**Must monitor w/ PTT; therapeutic range is 1.5-2.5x normal value
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*See [https://depts.washington.edu/anticoag/home/content/heparin-infusion-guidelines University of Washington pharmacy heparin infusion guidelines]
*33% of pts develop some form of bleeding complication; 2-6% develop major bleeding
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===Thromboembolism===
 +
*Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
 +
*Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
 +
*Adjust dose to target aPTT levels based on nomogram
 +
 
 +
==Pediatric Dosing==
 +
*IV infusion
 +
**Initial loading dose 75 units/kg given over 10 minutes
 +
**Initial maintenance dose 20 units/kg/hour and adjest per local policy
 +
 
 +
==Special Populations==
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*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
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*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
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*Renal Dosing
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**No adjustment
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*Hepatic Dosing
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**No adjustment
 +
 
 +
==Contraindications==
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*Allergy to class/drug
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*33% of patients develop some form of bleeding complication; 2-6% develop major bleeding
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*Heparin-Induced Thrombocytopenia
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*See [[HIT (Heparin-Induced Thrombocytopenia)]]
  
 
===Risk Factors for Major Bleeding Complication===
 
===Risk Factors for Major Bleeding Complication===
#Recent surgery or trauma
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*Recent surgery or trauma
#Renal failure
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*Renal failure
#Alcoholism
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*Alcoholism
#Malignancy
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*Malignancy
#Liver failure
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*Liver failure
#Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs
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*Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs
  
==Treatment ==
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==Pharmacology==
#See:
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*Half-life: 1.5 hrs
##[[DVT]]
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*Metabolism: Hepatic
##[[PE]]
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*Excretion: Urine
##[[NSTEMI]]
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*Mechanism of Action:
##[[STEMI]]
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**Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
 
+
*Anticoagulation effect lasts up to 3hr after stopping infusion
==Complications==
+
*Must give IV (not subq) for acute thromboembolic disease
#Bleeding
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**Unpredictable anticoagulation effect
##Treatment
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**Must monitor with PTT; therapeutic range is 1.5-2.5x normal value
###Managed according to clinical severity, NOT PTT value
 
####Heparin-associated bleeding is not always reflected by a supratherapeutic PTT
 
###Stop transfusion
 
###Observation alone may be appropriate in less severe cases
 
###Protamine
 
####Only indicated for major bleeding (0.2% of pts develop severe anaphylaxis)
 
####Give 1mg IV for every 100 units of UFH infused in the prior 3hr
 
####Give slowly over 1-3min; do not exceed 50mg in any 10 minute period
 
####Because half-life is short (7 min) may require second treatment
 
###Massive bleed
 
####Cryoprecipitate (10 U IV), then FFP (& platelets, aminocaproic acid infusion if nec)
 
#Heparin-Induced Thrombocytopenia
 
##See [[HIT (Heparin-Induced Thrombocytopenia)]]
 
  
 
==See Also==
 
==See Also==
*[[Low Molecular Weight Heparin]]
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*[[Unfractionated heparin reversal]]
*[[Bleeding Treatments]]
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*[[Coagulopathy (main)]]
*[[Coagulation Disorders]]
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*[[Low molecular weight heparin]]
  
==Source ==
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==References==
Tintinalli
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<references/>
  
[[Category:Heme/Onc]]
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[[Category:Pharmacology]]

Revision as of 19:08, 20 April 2019

General

  • Type: Anticoagulant
  • Dosage Forms: IV, SC
  • Common Trade Names: Heparin

Adult Dosing

Thromboembolism

  • Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
  • Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
  • Adjust dose to target aPTT levels based on nomogram

Pediatric Dosing

  • IV infusion
    • Initial loading dose 75 units/kg given over 10 minutes
    • Initial maintenance dose 20 units/kg/hour and adjest per local policy

Special Populations

Contraindications

Risk Factors for Major Bleeding Complication

  • Recent surgery or trauma
  • Renal failure
  • Alcoholism
  • Malignancy
  • Liver failure
  • Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs

Pharmacology

  • Half-life: 1.5 hrs
  • Metabolism: Hepatic
  • Excretion: Urine
  • Mechanism of Action:
    • Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
  • Anticoagulation effect lasts up to 3hr after stopping infusion
  • Must give IV (not subq) for acute thromboembolic disease
    • Unpredictable anticoagulation effect
    • Must monitor with PTT; therapeutic range is 1.5-2.5x normal value

See Also

References