Heparin Sodium

Introduction

Heparin Sodium is an anticoagulant that prevents the formation of blood clots. It is commonly used in medical settings to treat or prevent blood clots in veins, arteries, or the lungs. It is also used to prevent blood clotting during surgery, dialysis, and in blood samples drawn for laboratory purposes.

Uses

Heparin Sodium is used to:

Treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
Prevent clot formation during surgeries and medical procedures such as dialysis and cardiac surgery.
Maintain the patency of intravenous catheters.
Treat and prevent thromboembolic disorders associated with atrial fibrillation.

Brand Name	Heparin Sodium
Type
Weight
Generic	Heparin Sodium
Manufacturer
Available in	English বাংলা

Mechanism of Action

Heparin works by activating antithrombin III, which in turn inhibits thrombin and factor Xa, key enzymes involved in the blood coagulation cascade. By inhibiting these enzymes, Heparin prevents the formation of fibrin clots, which are essential to the blood clotting process.

How Long Does It Take to Work?

Heparin Sodium begins to work almost immediately after intravenous administration, with the effects becoming noticeable within minutes. For subcutaneous administration, the onset of action is typically between 20 to 60 minutes.

Absorption

Heparin is poorly absorbed from the gastrointestinal tract, which is why it is not administered orally. It is typically administered intravenously or subcutaneously for effective absorption into the bloodstream.

Route of Elimination

Heparin is metabolized in the liver, primarily by the enzyme heparinase, and is eliminated via the kidneys. However, the exact route of elimination for the active compound is not fully understood.

Dosage

Intravenous-
Prophylaxis of re-occlusion of the coronary arteries following thrombolytic therapy in myocardial infarction

Adult: 60 U/kg (max: 4,000 U) or a bolus of 5,000 U if streptokinase was used, followed by 12 U/kg/hr (max: 1,000 U/hr) w/ a treatment duration of 48 hr.

Intravenous-
Peripheral arterial embolism, Unstable angina, Venous thromboembolism

Adult: 75-80 U/kg or 5,000 U (10,000 U in severe pulmonary embolism) IV loading dose followed by 18 U/kg or 1,000-2,000 U/hr continuous infusion. Alternatively, intermittent inj of 5,000-10,000 U 4-6 hrly.
Child: 50 U/kg loading dose, followed by an infusion of 15-25 U/kg/hr.
Elderly: Lower dosages may be required.

Subcutaneous-
Prophylaxis of postoperative venous thromboembolism

Adult: 5,000 U given 2 hr before surgery then 8-12 hrly for 7 days or until the patient is ambulant.

Subcutaneous-
Venous thromboembolism

Adult: 15,000-20,000 U 12 hrly or 8,000-10,000 U 8 hrly.
Child: 250 U/kg bid.
Elderly: Lower dosages may be required.

Dosage varies based on the condition being treated:

Treatment of DVT/PE: 80 units/kg as an initial IV bolus followed by continuous infusion of 18 units/kg per hour.
Prophylaxis of DVT: 5,000 units subcutaneously every 8 to 12 hours.
Surgical anticoagulation: 150 to 400 units/kg during cardiac surgery.

Administration

Heparin Sodium is typically administered via intravenous or subcutaneous injection. Intravenous administration provides immediate anticoagulant effects, while subcutaneous administration has a slower onset but maintains anticoagulation for longer periods.

Side Effects

Common side effects include:

Bleeding or bruising at the injection site.
Prolonged bleeding from cuts.
Decreased platelet count (thrombocytopenia).

Serious side effects may include:

Heparin-induced thrombocytopenia (HIT), a severe immune-mediated reduction in platelet counts.
Severe bleeding, particularly in patients with underlying bleeding disorders or those receiving high doses of heparin.

Toxicity

Overdose of Heparin can lead to life-threatening bleeding. Protamine sulfate can be administered as an antidote to neutralize the anticoagulant effects of heparin. The dose of protamine sulfate is calculated based on the amount of heparin administered.

Precautions

Precautions include:

Careful monitoring of activated partial thromboplastin time (aPTT) in patients receiving heparin to ensure safe and effective anticoagulation.
Use with caution in patients with a history of bleeding disorders, liver or kidney disease, or those undergoing invasive procedures.
Avoiding use in patients with a known history of heparin-induced thrombocytopenia (HIT).

Interaction

Heparin may interact with:

Nonsteroidal anti-inflammatory drugs (NSAIDs), increasing the risk of bleeding.
Other anticoagulants like warfarin or direct oral anticoagulants, enhancing the anticoagulant effect and increasing bleeding risk.
Thrombolytic agents, which may increase the risk of severe bleeding.

Disease Interaction

Heparin should be used with caution in patients with:

Severe hypertension or bleeding disorders.
Liver or kidney dysfunction, as these conditions can affect heparin clearance and increase the risk of bleeding.
A history of heparin-induced thrombocytopenia (HIT).

Drug Interaction

Drug interactions include:

Increased risk of bleeding when combined with other anticoagulants, antiplatelet agents, or thrombolytic agents.
Potential for decreased anticoagulant effect when used with digitalis, tetracyclines, or nicotine.

Food Interactions

There are no significant food interactions with Heparin. However, patients should avoid foods that may increase the risk of bleeding, such as garlic, ginger, and high doses of vitamin E.

Pregnancy Use

Heparin Sodium is considered safe for use during pregnancy and is often used for anticoagulation in pregnant women due to its inability to cross the placenta. However, it should be used under close medical supervision.

Lactation Use

Heparin is not excreted in significant amounts into breast milk, making it generally safe for use during lactation. However, monitoring the infant for signs of bruising or bleeding is advisable.

Acute Overdose

Acute overdose of heparin can result in severe bleeding complications. Protamine sulfate is the antidote used to reverse the effects of heparin, and its administration should be based on the dose of heparin received.

Contraindication

Heparin is contraindicated in patients with:

Active bleeding, such as gastrointestinal or intracranial bleeding.
Severe thrombocytopenia or a history of heparin-induced thrombocytopenia (HIT).
Hypersensitivity to heparin or any component of the formulation.

Use Direction

Heparin should be administered exactly as prescribed by a healthcare provider. Dosage and administration technique vary based on the clinical indication and patient condition. Patients should be closely monitored for signs of bleeding and any adverse reactions.

Storage Conditions

Heparin Sodium should be stored at room temperature, away from moisture and heat. Do not freeze. Ensure it is kept out of the reach of children.

Volume of Distribution

The volume of distribution of heparin is low, as it remains primarily within the vascular system. Heparin is highly protein-bound, which limits its distribution to tissues outside the blood.

Half Life

The half-life of heparin varies depending on the dose and route of administration, generally ranging from 1 to 2 hours. This can be prolonged in patients with liver or kidney dysfunction.

Clearance

Heparin is cleared primarily by the reticuloendothelial system, with a smaller portion metabolized by the liver. Renal excretion plays a minor role in its clearance. Clearance may be impaired in patients with liver or kidney disease.

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