HEPARIN

Indications & Dose:

Deep vein thrombosis (DVT), pulmonary embolism (PE), peripheral arterial embolism: coagulopathies (e.g., disseminated intravascular coagulation): DVT/PE prophylaxis; clotting prevention in arterial and heart surgery, blood transfusions, extracorporeal circulation, dialysis and blood samples; prophylaxis of LV thrombi and CVA after MI*; evolving stroke*; adjunctive therapy of coronary occlusion with acute MI*

• BY INJECTION

 Treatment of deep-vein thrombosis and pulmonary embolism, by intravenous injection, loading dose of 5000 units (10000 units in severe pulmonary embolism follo-wed by continuous infusion of 1000-15000 units every 12 hours (laboratory monitoring essential - preferably on a daily basis).small , adultand child lower loading dose the, 15-25, units/kg/hour by intravenous infusion, or 250 units/kg every 12 hours by subcutaneous injection. Unstabl angina, acute peripheral arterial occlusion, asintravenous regimen for deep-vein thrombosis andpulmonary embolism, Prophylaxis of deep veinthrombosis  and  pulmonary  embolism,  by subcutaneous injection, 5000 units 2 hours beforesurery, then every 8-12 hours for 7 days or untilpatient is ambulant (monitoring not needed); during pregnancy (with monitoring) 5000-10000 units every12 hours (important: not intended to cover prevention of prosthetic heart valve thrombosis in pregnancy which call for separate specialist management). MYOCARDIAL INFARCTION.  for the prevention of coronary re-occlusion after thrombolysis heparin is used in variety of regimens according to locally agreed protocols. For theprevention of mural thrombosis heparin is considered effective when given by subcutaneousinjection of 12500 units every 12 hours for atleast 10 days.

Contraindications:

Severethrombocytopenia, uncontrolled bleeding (exceptwhen  due  to  DIC),  suspected  intracranial hemorrhage, shock, severe hypotension.

Side Effects:

CNS: Fever, headache

CV: Allergic vasospastic reactions, shock

EENT: Lacrimation, rhinitis

GI: Nausea, vomiting

GU: Hematuria, priapisminduced

HEME:  Hemorrhage,  heparin thrombocytopenia (HIT), white clot syndrome(new thrombus formation associated withheparin administration)

METAB: Rebound hyperlipidemia, suppressed aldosterone synthesis,

MS: Osteoporosis (afterlong-term, high doses)

RESP: Anaphylactoid reactions, asthma

SKIN: Chills, cutaneous necrosis, delayedtransient alopecia, era, hematoma/ulceration,histamine-like reactions, local irritation, urticaria

Cautions:

Precautions:

IM inj (avoid due to risk forhematoma), elderly, children, diabetes, renalinsufficiency, severe hypertension, subacute bacterial endocarditis, acute nephritis, peptic ulcerdisease, severe renal disease

Pregnancy; does not cross the placenta, has majoradvantages over oral anticoagulants as the treatment of choice during pregnancy; is notexcreted into breast milk due to its high molecular weight

Interaction:

Drugs

Aspirin: Increased risk of hemorrhage

Warfarin: Warfarin may prolong the aPTT in patients receiving heparin; heparin may prolong the PT inpatients receiving warfarin

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: