Difference between revisions of "Unfractionated heparin"
Ostermayer (talk | contribs) (Text replacement - " pts" to " patients") |
(→Adult Dosing) |
||
| (6 intermediate revisions by 4 users not shown) | |||
| Line 5: | Line 5: | ||
==Adult Dosing== | ==Adult Dosing== | ||
| + | *See [https://depts.washington.edu/anticoag/home/content/heparin-infusion-guidelines University of Washington pharmacy heparin infusion guidelines] | ||
===Thromboembolism=== | ===Thromboembolism=== | ||
*Bolus: 80 units/kg IV x 1 (MAX: 5,000 units) | *Bolus: 80 units/kg IV x 1 (MAX: 5,000 units) | ||
*Then drip: 18 units/kg/h IV (MAX: 1,000 units/h) | *Then drip: 18 units/kg/h IV (MAX: 1,000 units/h) | ||
*Adjust dose to target aPTT levels based on nomogram | *Adjust dose to target aPTT levels based on nomogram | ||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
| Line 24: | Line 17: | ||
==Special Populations== | ==Special Populations== | ||
| − | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | + | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C |
| − | *Lactation: | + | *[[Lactation risk categories|Lactation risk]]: Infant risk minimal |
*Renal Dosing | *Renal Dosing | ||
**No adjustment | **No adjustment | ||
| Line 38: | Line 31: | ||
===Risk Factors for Major Bleeding Complication=== | ===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== | ==Pharmacology== | ||
| Line 54: | Line 47: | ||
*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 | + | **Must monitor with PTT; therapeutic range is 1.5-2.5x normal value |
==See Also== | ==See Also== | ||
| − | *[[ | + | *[[Unfractionated heparin reversal]] |
| − | *[[ | + | *[[Coagulopathy (main)]] |
| − | *[[ | + | *[[Low molecular weight heparin]] |
==References== | ==References== | ||
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