Known brand names include No current brand name; marketed as generic heparin sodium injection.
An injectable blood thinner given IV or under the skin, mostly in the hospital. It prevents and treats blood clots and works within minutes when given IV.
Labeled use. Acute and chronic consumption coagulopathies.
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Preferred when rapid, titratable, quickly reversible anticoagulation is needed: acute VTE or ACS in hospital, procedures, dialysis circuits, and severe renal impairment where LMWH accumulates. It is the usual bridge while warfarin reaches a therapeutic INR. LMWH is often chosen instead for outpatient treatment because it needs no routine aPTT monitoring and causes less HIT.
Binds antithrombin III and greatly speeds its inactivation of clotting factors, especially factor Xa and thrombin (IIa). It also blocks fibrin stabilization. It does not break down existing clots. IV half-life is about 30 minutes for reversal dosing.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
No fixed renal dose change; titrate by coagulation tests. Severe renal disease raises bleeding risk, and chronic renal failure raises hyperkalemia risk.
No fixed hepatic dose change; titrate by coagulation tests. Liver disease with impaired hemostasis raises bleeding risk.
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None on the current label. Fatal medication errors from vial strength mix-ups are a labeled warning.
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Protamine sulfate. About 1 mg neutralizes 100 units of heparin; give by slow infusion, no more than 50 mg in any 10 minutes. Less is needed as time passes because heparin is cleared quickly. Protamine can cause anaphylaxis-like reactions, so have resuscitation ready.
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Published reports show no increase in adverse maternal or fetal outcomes. Use a preservative-free product when possible during pregnancy.
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Heparin's large molecule is unlikely to enter milk, and any that does would not be absorbed orally by the infant.
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Use preservative-free heparin in neonates and infants. Suggested start: 75 to 100 units/kg IV bolus over 10 minutes, then 25 to 30 units/kg/hour in infants or 18 to 20 units/kg/hour in children over 1 year. Adjust to an aPTT of 60 to 85 seconds.
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Bleeding is more frequent in patients over 60, especially women. Lower doses may be appropriate.
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