Unfractionated heparin: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
===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 | |||
===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 | *Adjust dose to target aPTT levels based on nomogram | ||
| Line 27: | Line 31: | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*33% of patients develop some form of bleeding complication; 2-6% develop major bleeding | *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=== | ||
| Line 37: | Line 40: | ||
*Liver failure | *Liver failure | ||
*Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs | *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== | ||
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/