Unfractionated heparin: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: [[Anticoagulant]] | ||
*Dosage Forms: IV, SC | *Dosage Forms: IV, SC | ||
*Common Trade Names: | *Common Trade Names: Heparin | ||
==Adult Dosing== | ==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 | |||
===Acute Coronary Syndrome=== | |||
*Bolus: 50 units/kg IV x 1 (MAX: 5,000 units) | |||
*Then drip: 12 units/kg/h IV (MAX: 1,000 units/h) | |||
*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]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*Lactation: | *[[Lactation risk categories|Lactation risk]]: Infant risk minimal | ||
*Renal Dosing | *Renal Dosing | ||
** | **No adjustment | ||
*Hepatic Dosing | *Hepatic Dosing | ||
** | **No adjustment | ||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*33% of | *33% of patients develop some form of bleeding complication; 2-6% develop major bleeding | ||
* | *[[HIT (Heparin-Induced Thrombocytopenia)]] | ||
===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 | |||
==Adverse Reactions== | |||
===Serious=== | |||
*Major bleeding | |||
*Thrombocytopenia | |||
===Common=== | |||
*Injection site reaction<ref>Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/</ref> | |||
*Hyperkalemia | |||
*Alopecia | |||
*Osteoporosis | |||
==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 1.5 hrs | ||
*Metabolism: | *Metabolism: Hepatic | ||
*Excretion: | *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 | **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/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
Latest revision as of 17:56, 25 January 2023
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
Acute Coronary Syndrome
- Bolus: 50 units/kg IV x 1 (MAX: 5,000 units)
- Then drip: 12 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
- 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
Adverse Reactions
Serious
- Major bleeding
- Thrombocytopenia
Common
- Injection site reaction[1]
- Hyperkalemia
- Alopecia
- Osteoporosis
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
- ↑ Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/