Heparin

Heparin

Brand Name: heparin sodium injection, Hepalean (CAN), Heparin Leo (CAN)

 

Pregnancy Category C

Drug class: Anticoagulant,

 

 

Therapeutic actions

Inhibits thrombus and clot formation by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin, the final steps in the clotting process.

 

 

Indications

· Prevention and treatment of venous thrombosis and pulmonary embolism

· Treatment of atrial fibrillation with embolization

· Diagnosis and treatment of DIC

· Prevention of clotting in blood samples and heparin lock sets and during dialysis procedures

· Unlabeled uses: adjunct in therapy of coronary occlusion with acute MI, prevention of left ventricular thrombi and CVA post-MI, prevention of cerebral thrombosis in the evolving stroke

 

 

Contraindications

· Hypersensitivity to heparin; severe thrombocytopenia; uncontrolled bleeding; any patient who cannot be monitored regularly with blood coagulation tests; labor and immediate postpartum period; women older than 60 yr are at high risk for hemorrhaging; dysbetalipoproteinemia; recent surgery or injury.

 

 

Adverse effects

Loss of hair

Hemorrhage; bruising; thrombocytopenia; elevated AST, ALT levels, hyperkalemia

Chills, fever, urticaria, asthma

Osteoporosis, suppression of renal function (long-term, high-dose therapy)

 

Drug Interactions:

· Increased bleeding tendencies with oral anticoagulants, salicylates, penicillins, cephalosporins

· Decreased anticoagulation effects if taken concurrently with nitroglycerin

 

 

Nursing considerations

· Adjust dose according to coagulation test results performed just before injection (30 min before each intermittent dose or q 4 hr if continuous IV dose). Therapeutic range APTT: 1.5–2.5 times control.

· Use heparin lock needle to avoid repeated injections.

· Give deep SC injections; do not give heparin by IM injection.

· Do not give IM injections to patients on heparin therapy (heparin predisposes to hematoma formation).

· Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma; do not massage injection sites.

· Mix well when adding heparin to IV infusion.

· Do not add heparin to infusion lines of other drugs, and do not piggyback other drugs into heparin line. If this must be done, ensure drug compatibility.

· Provide for safety measures (electric razor, soft toothbrush) to prevent injury from bleeding.

· Check for signs of bleeding; monitor blood tests.

· Alert all health care providers of heparin use.

· Have protamine sulfate (heparin antidote) on standby in case of overdose; each mg neutralizes 100 units of heparin.