Difference between revisions of "Unfractionated heparin"
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| − | == | + | ==General== |
| − | *Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin | + | *Type: Anticoagulant |
| − | * | + | *Dosage Forms: IV, SC |
| + | *Common Trade Names: Heparin | ||
| + | |||
| + | ==Adult Dosing== | ||
| + | *See [https://depts.washington.edu/anticoag/home/content/heparin-infusion-guidelines University of Washington pharmacy heparin infusion guidelines] | ||
| + | ===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== | ||
| + | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
| + | *[[Lactation risk categories|Lactation risk]]: Infant risk minimal | ||
| + | *Renal Dosing | ||
| + | **No adjustment | ||
| + | *Hepatic Dosing | ||
| + | **No adjustment | ||
| + | |||
| + | ==Contraindications== | ||
| + | *Allergy to class/drug | ||
| + | *33% of patients develop some form of bleeding complication; 2-6% develop major bleeding | ||
| + | *Heparin-Induced Thrombocytopenia | ||
| + | *See [[HIT (Heparin-Induced Thrombocytopenia)]] | ||
| + | |||
| + | ===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 | *Must give IV (not subq) for acute thromboembolic disease | ||
| − | * | + | **Unpredictable anticoagulation effect |
| − | *Unpredictable anticoagulation effect | + | **Must monitor with PTT; therapeutic range is 1.5-2.5x normal value |
| − | **Must monitor | ||
| − | == | + | ==See Also== |
| − | + | *[[Unfractionated heparin reversal]] | |
| − | + | *[[Coagulopathy (main)]] | |
| − | + | *[[Low molecular weight heparin]] | |
| − | |||
| − | |||
| − | == | + | ==References== |
| − | + | <references/> | |
| − | [[Category: | + | [[Category:Pharmacology]] |
Revision as of 19:08, 20 April 2019
Contents
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
- Pregnancy Rating: C
- Lactation risk: Infant risk minimal
- Renal Dosing
- No adjustment
- Hepatic Dosing
- No adjustment
Contraindications
- Allergy to class/drug
- 33% of patients develop some form of bleeding complication; 2-6% develop major bleeding
- Heparin-Induced Thrombocytopenia
- See HIT (Heparin-Induced Thrombocytopenia)
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