Difference between revisions of "Unfractionated heparin"

(Adult Dosing)
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==General==
 
==General==
*Type:  
+
*Type: Anticoagulant
*Dosage Forms:
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*Dosage Forms: IV, SC
*Common Trade Names:  
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*Common Trade Names: Heparin
  
 
==Adult Dosing==
 
==Adult Dosing==
#See:
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*See [https://depts.washington.edu/anticoag/home/content/heparin-infusion-guidelines University of Washington pharmacy heparin infusion guidelines]
##[[DVT]]
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===Thromboembolism===
##[[PE]]
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*Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
##[[NSTEMI]]
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*Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
##[[STEMI]]
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*Adjust dose to target aPTT levels based on nomogram
  
 
==Pediatric Dosing==
 
==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==
 
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Safe in pregnancy
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*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*Lactation:
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*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
 
*Renal Dosing
 
*Renal Dosing
**Adult
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**No adjustment
**Pediatric
 
 
*Hepatic Dosing
 
*Hepatic Dosing
**Adult
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**No adjustment
**Pediatric
 
  
 
==Contraindications==
 
==Contraindications==
 
*Allergy to class/drug
 
*Allergy to class/drug
*33% of pts develop some form of bleeding complication; 2-6% develop major bleeding
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*33% of patients develop some form of bleeding complication; 2-6% develop major bleeding
 
*Heparin-Induced Thrombocytopenia
 
*Heparin-Induced Thrombocytopenia
 
*See [[HIT (Heparin-Induced Thrombocytopenia)]]
 
*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
  
 
==Pharmacology==
 
==Pharmacology==
*Half-life:  
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*Half-life: 1.5 hrs
*Metabolism:  
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*Metabolism: Hepatic
*Excretion:  
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*Excretion: Urine
 
*Mechanism of Action:
 
*Mechanism of Action:
 
+
**Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
 
 
*Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
 
 
*Anticoagulation effect lasts up to 3hr after stopping infusion
 
*Anticoagulation effect lasts up to 3hr after stopping infusion
 
*Must give IV (not subq) for acute thromboembolic disease
 
*Must give IV (not subq) for acute thromboembolic disease
 
**Unpredictable anticoagulation effect
 
**Unpredictable anticoagulation effect
**Must monitor w/ PTT; therapeutic range is 1.5-2.5x normal value
+
**Must monitor with PTT; therapeutic range is 1.5-2.5x normal value
  
 
==See Also==
 
==See Also==
*[[Coagulopathy (Main)]]
+
*[[Unfractionated heparin reversal]]
*[[Low Molecular Weight Heparin]]
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*[[Coagulopathy (main)]]
*[[Heparin reversal]]
+
*[[Low molecular weight heparin]]
  
==Sources==
+
==References==
 
<references/>
 
<references/>
  
[[Category:Drugs]]
+
[[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