Heparin

DEA Class; Rx

Common Brand Names; Hep-Lock, Hep-Lock U/P, Hepflush-10, Monoject Prefill Advanced Heparin Lock Flush, SASH Normal Saline and Heparin

• Anticoagulants, Cardiovascular; 
• Anticoagulants, Hematologic

History of pentosan polysulfate-induced thrombocytopenia (HIT) (with or without thrombosis)

Uncontrolled, active bleeding (except DIC)

Conditions in which coagulation tests cannot be performed at appropriate intervals

Cases where the administration of sodium or chloride could be clinically detrimental (large volume heparin 2 unit/mL IV solutions only)

Known hypersensitivity to heparin or pork products

Any risk factor for hemorrhage (eg, subacute bacterial endocarditis, blood dyscrasias, menorrhagia, dissecting aneurysm, major surgery, spinal anesthesia, hemophilia, GI ulcerative lesions, liver disease, impaired hemostasis)

Hemorrhage can occur at virtually any site in patients receiving heparin; a higher incidence of bleeding reported in patients, particularly women, over 60 years of age; an unexplained fall in hematocrit, fall in blood pressure, or any other unexplained symptom should lead to serious consideration of a hemorrhagic event

Monitor therapy with aPTT

Heparin may prolong PT

Potential medication errors: Do not use heparin sodium injection as a catheter lock-flush product; heparin sodium injection is supplied in vials containing various strengths of heparin; these include vials containing a highly concentrated solution of 10,000 units in 1 mL, which have been mistaken for 1 mL low-concentration catheter lock-flush vials

Geriatric dosing: Lower doses may be necessary; patients over 60 years may have enhanced serum levels and response compared with patients under 60 years receiving similar dosages

Heparin sodium may prolong one-stage prothrombin time; when heparin sodium is given with dicumarol or warfarin sodium, a period of at least 5 hr after last intravenous dose or 24 hr after last subcutaneous dose should elapse before blood is drawn if a valid prothrombin time is to be obtained

If preserved with benzyl alcohol, do not administer to neonates, infants, pregnant women, or breastfeeding women; benzyl alcohol has been associated with serious adverse events and death, particularly in pediatric patients (gasping syndrome)

Anticoagulant effect of heparin is enhanced by concurrent treatment with antithrombin III (human) in patients with hereditary antithrombin III deficiency; to reduce risk of bleeding, reduce heparin dose during concomitant treatment with antithrombin III (human)

Osteoporosis may occur with prolonged ( >6 months) use due to a reduction in mineral bone density

Some preparations may contain sulfite which may cause allergic reactions

Serious and fatal adverse reactions including “gasping syndrome” can occur in neonates and infants treated with benzyl alcohol-preserved drugs; consider combined daily metabolic load of benzyl alcohol from all sources including heparin sodium injection multiple-dose vials and other drugs containing benzyl alcohol hen prescribing multiple-dose vials in infants; minimum amount of benzyl alcohol at which toxicity may occur is not known

There are no available data on heparin sodium injection use in pregnant women to inform a drug- associated risk of major birth defects and miscarriage; in published reports, heparin exposure during pregnancy did not show evidence of increased risk of adverse maternal or fetal outcomes in humans

There is no information regarding presence of heparin sodium injection in human milk, effects on breastfed infant, or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for heparin sodium injection and potential adverse effects on breastfed infant from therapy or from the underlying maternal condition