Heparin

Heparin sodium is an anticoagulant agent derived from animal mucosa.

* It may be given by continuous IV infusion in the treatment of VTE, i.e. PE and DVT, STEMI and also
in the acute coronary syndromes: unstable angina and NSTEMI, particularly where #renal function
precludes the use of some LMWHs.

* It is used for prophylaxis of VTE in surgical and medical patients and to prevent thrombus
formation in extracorporeal circulation during haemodialysis.

* It may be used to maintain patency of central intravenous lines.

* Heparin calcium has also been used for the prophylaxis and treatment of VTE in similar doses to
heparin sodium.

precautions

1- Do not use in patients who are haemorrhaging.

2- Use extreme care in those at serious risk of haemorrhage, e.g. in cases of haemorrhagic
blood disorders, thrombocytopenia, peptic ulcer disease, cerebrovascular disorders, bacterial
endocarditis, severe “BP, oesophageal varices, or after recent surgery where haemorrhage remains
a risk.

3- Caution in hepatic and renal impairment, and in elderly patients.

Dose
Prophylaxis
General or orthopedic surgery with high risk of VTE: 5000 units by SC injection 2 hours
preoperatively and then every 8-12 hours until the patient is mobile.
VTE prophylaxis in other patients: 5000 units SC every 8-12 hours.
Treatment
Standard dose using heparin by IV infusion: 5000 units by IV injection (for major PE give
10 000 units) followed by 18 units/kg/hour* by IV infusion adjusting to APTT or APTT ratio.
* Omit the loading dose if initial APTT ratio is 1.5–2.5.
* If initial APTT ratio is > 2.5 review the need to start therapy.
*Many hospitals use an initial rate of 1000 units/hour for all patients, then check APTT or APTT ratio
after 2-6 hours and adjust rate accordingly. 

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