Heparin

Heparin Information

Heparin is indicated for the prophylaxis and treatment of Thromboembolic disorders such as thrombophlebitis, pulmonary embolism and occlusive vascular disease. It is also used to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, dialysis and other perfusion procedures. Heparin is also used as an anticoagulant in blood transfusions.

Heparin Warnings

Heparin should not be given by intramuscular injection, due to the risk of haematoma formation. Heparin therapy should be monitored carefully. Adequate monitoring of therapy reduces the risk of overdosage and consequent risk of haemorrhage and is an important guide to the development of serious adverse reactions such as delayed onset thrombocytopenia. Patients on heparin may rarely develop Heparin-induced Thrombosis-Thrombocytopenia Syndrome (HITTS or "white clot syndrome"): new thrombus formation in association with thrombocytopenia, as a result of irreversible platelet aggregation. This may lead to severe thromboembolic complications such as skin necrosis, gangrene of the extremities, myocardial infarction, pulmonary embolism and stroke. Heparin administration should therefore be discontinued if a patient develops new thrombosis in association with thrombocytopenia. Any action which may cause vascular injury, with the exception of necessary intravenous or subcutaneous injections, should be avoided where possible. Heparin should be administered with caution to patients with hepatic or renal disease, hypertension, a history of ulcers, or with vascular diseases of the chorio-retina. Dosage reduction may be necessary in patients with advanced renal or hepatic disease. Increased resistance to heparin is frequently encountered with fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies, myocardial infarction, cancer and in post-surgical patients. Heparin therapy increases the risk of localised haemorrhage during and following oral surgical (dental) procedures. Temporary heparin dosage reduction or withdrawal may therefore be advisable prior to oral surgery. The use of heparin in pregnancy has the usual risks for the mother, in particular osteoporosis and thrombocytopenia. Heparin is not distributed into milk and heparin therapy is therefore not contraindicated in women who are breast-feeding. Heparin Injection vials contain benzyl alcohol as a preservative, and should not be administered to premature or low birth-weight neonates. Drugs which affect platelet function, eg aspirin, other salicylates and other non-steroidal anti-inflammatory agents, dextran, dipyridamole and systemic corticosteroids, may increase the risk of haemorrhage and should be used with caution in patients receiving heparin. Where concomitant use cannot be avoided, careful clinical and biological monitoring should be undertaken.

Heparin Side effects

Haemorrhage is the major risk of heparin therapy and may range from minor local ecchymoses to major haemorrhagic complications. An overly prolonged clotting time or minor bleeding can usually be controlled by discontinuing the heparin . The occurrence of significant gastrointestinal or urinary tract bleeding during heparin therapy may indicate the presence of an underlying occult lesion. Bleeding can occur at any site, but some specific haemorrhagic complications can be difficult to detect. a) Adrenal haemorrhage with resultant acute adrenal insufficiency has occurred during anticoagulant therapy. Anticoagulant treatment should be discontinued in patients who develop signs and symptoms of acute adrenal haemorrhage and insufficiency. Plasma cortisol levels should be measured immediately. Corticosteroid therapy should be initiated promptly, before laboratory confirmation of the diagnosis, as any delay in treatment may result in the patient's death. b) Ovarian (corpus luteum) haemorrhage may be fatal if unrecognised. c) Retroperitoneal haemorrhage. Thrombocytopenia has been reported to occur in up to 30% of patients receiving heparin. Although the thrombocytopenia is often mild and of no obvious clinical significance, it may be accompanied by severe thromboembolic complications such as skin necrosis, gangrene of the extremities, myocardial infarction, pulmonary embolism and stroke (see Precautions). Certain episodes of painful, ischaemic and cyanosed limbs have in the past been attributed to allergic vasospastic reactions; however these reactions may instead be complications of thrombocytopenia. Delayed onset thrombocytopenia is also a possible complication of heparin therapy. If this occurs, the drug should be withdrawn immediately. Skin necrosis has infrequently been reported at injection sites. It is thought to be a localised manifestation of heparin-induced platelet aggregation and thrombosis, and should be taken as a warning sign in patients who develop it. Heparin should be discontinued immediately. Local irritation, erythema, mild pain, haematoma or ulceration may follow deep subcutaneous injection. The emergence of firm nodules may be noted in some cases; however, these nodules usually disappear after a few days.

Heparin Overdose

Slight haemorrhage due to overdosage can usually be treated by withdrawing the drug. Severe bleeding may be reduced by the administration of protamine sulphate. Protamine sulphate should be administered intravenously. To avoid circulatory side effects, the injection should be given slowly at a rate of 5mL over a period of about 10 minutes. Not more than 50mg should be given at any one time. The dose of protamine sulphate required is governed by the amount of heparin that has to be neutralised; approximately 1mg of protamine sulphate neutralises 110 units of heparin (mucous) that has been injected in the previous 15 minutes.

Heparin Usage guidelines

Heparin may be given by intermittent intravenous injection, intravenous infusion or deep subcutaneous injection. It should not be given intramuscularly because of the danger of haematoma formation Store below 25°C.

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