HEPARIN

Anticoagulant

Dosage Forms

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Injection

5000 IU/ml

Uses

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  • Deep vein thrombosis (DVT)
  • Pulmonary embolism

Dose and Duration

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Treatment of deep vein thrombosis, pulmonary embolism
  • Adult: by IV injection, loading dose 5,000 IU (10,000 IU in severe pulmonary embolism) followed by continuous IV infusion of 18 IU/kg/hour or by SC injection of 15,000 IU every 12 hours for 5 days. Adjust dose based on response
  • Child 1–18 years: loading dose, 75 IU/kg by IV injection, then by continuous IV infusion 20 IU/kg/hour adjusted according to activated partial thromboplastin time (APTT)
  • By SC injection, 250 IU/kg every 12 hours
  • Child 1 month–1 year: by IV injection, loading dose of 75 IU/kg then 25 IU/kg/hour by continuous IV infusion adjusted according to APTT
  • Neonate: loading dose of 75 IU/kg (50 IU/kg if under 35 weeks postmenstrual age) by IV injection, then 25 IU/kg/hour by continuous IV infusion adjusted according to APTT
Prophylaxis of deep vein thrombosis or pulmonary embolism
  • Adult: by SC injection, 5000 IU 2 hours before surgery then 5000 IU every 8–12 hours for 7 days or until patient is able to walk around
  • Use same dose in medical and post-surgery patients
  • Child 1 month–18 years: 100 IU/kg (max 5000 IU) every 12 hours adjusted according to APTT
  • Pregnancy: by SC injection, 5000–10,000 IU every 12 hours

Preparation

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  • Dilute with glucose 5% or sodium chloride 9% for continuous intravenous infusion

Contraindications

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  • Hypersensitivity to unfractionated or low-molecular weight heparin
  • Haemophilia and other haemorrhagic disorders
  • Thrombocytopenia and history of heparin-induced thrombocytopenia
  • Peptic ulcer
  • Recent cerebral haemorrhage
  • Severe hypertension
  • Severe liver and renal disease
  • Acute bacterial endocarditis
  • Following major trauma or recent surgery to eye or nervous system

Side Effects

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  • Immune-mediated thrombocytopenia
  • Haemorrhage
  • Temporary rise in aminotransferases and lipase levels
  • Local irritation
  • Skin necrosis
  • Osteoporosis after prolonged use

Interactions

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  • Acetyl salicylic acid (enhanced anticoagulant effect)
  • Glyceryl trinitrate (reduced anticoagulant effect)
  • Intravenous diclofenac (increased risk of haemorrhage)

Pregnancy

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  • Can be used

Breast-feeding

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  • Can be used

⚠️ Caution

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  • Prevention of prosthetic heart-valve thrombosis in pregnancy requires specialist management
  • Use with caution in patients requiring spinal or epidural anaesthesia due to risk of spinal haematoma
  • Elderly may require reduced doses
  • Monitor platelets in patients receiving treatment for longer than 5 days. Withdraw immediately if thrombocytopenia is strongly suspected or confirmed
  • Use with caution in patients with diabetes mellitus, chronic renal failure, acidosis, raised plasma potassium or those taking potassium-sparing drugs, as there is increased risk of hyperkalaemia
  • Reduce dose in hepatic and renal impairment or avoid in severe impairment due to increased risk of bleeding
  • Do not use preparations with benzyl alcohol in pregnancy