Heparin. 25,000 I.U. 1 BRAUN
prevention and treatment of embolism (e.g. pulmonary embolism, atrial fibrillation with embolization, peripheral arterial embolism);
treatment of acute and chronic consumptive coagulopathy (DIC), prevent blood clotting in arterial and cardiac surgery;
Heparin. 25,000 I.U. 1 BRAUN
Potentiates the action of antithrombin III and inactivate thrombin . Blocking the conversion of fibrinogen into fibrin. The anticoagulant effect is demonstrated in vivo, and in vitro. Heparin inhibits thrombin-induced aggregation and adhesion of platelets. Enables the fibrinolytic properties of blood. Heparin prolongs the clotting time in proportion to the dose administered . It slows the plasma recalcification . The anticoagulant effect occurs very rapidly after iv injection and lasts for about 6 h. Heparin reduces the lipid content in the blood, possibly due to the release of lipoprotein lipase , hydrolysing triglycerides into free fatty acids. Improves coronary blood flow , a weak vasodilatory effect blocking hyaluronidase .
prophylaxis and treatment of venous thrombosis ;
prevention and treatment of embolism (e.g. pulmonary embolism , atrial fibrillation with embolization , peripheral arterial embolism ) ;
treatment of acute and chronic consumptive coagulopathy (DIC ) , prevent blood clotting in arterial and cardiac surgery ;
as an anticoagulant in blood transfusions , extracorporeal circulation , dialysis procedures , taking blood samples for laboratory purposes .
2 . Dosage and method of administration
Dosing should be treated individually to obtain the desired effects (typically 1,5-2,5 aPTT).
Intravenous administration to thrombophlebitis or pulmonary embolism
A continuous infusion of 50-100 IU / kg initially and then at 15-25 IU / kg / h;
Alternatively it may be applied 5000 IU initially and then at 1000 IU / h.
The duration of therapy in thrombophlebitis or pulmonary thromboembolism is 7-10 days , followed by oral anticoagulation (recommended start in the first 24 h of administration of heparin).
Subcutaneous administration in thrombosis or pulmonary embolism
10000-20000 IU initially ( shown by 5000 IU iv loading dose ) followed 8000-10000 IU/8h or 15000-20000 IU/12h.
Subcutaneously for prophylaxis of deep vein thrombosis ( DVT)
5000 IU 2h before surgery and then every 8-12 h for 5-7 days or until the patient is discharged .
If the clotting time exceed 2 times the normal value , the dosage of heparin sodium should be reduced , otherwise it should be increased. Daily dose heparin but should never exceed 60,000 to 80,000 IU and it can not be applied for a period longer than 10 days ( except in special cases). Although heparin sodium may also be administered for prophylaxis , heparin calcium ampoules is better suited for this purpose.
For the prevention of thrombosis has to be applied daily dose 2 times 1 ml ( 2 x 5000 IU) heparin sodium subcutaneously in the abdomen .
Paediatric in the children were given a starting dose of 50 IU / kg body weight by intravenous infusion followed From 100 IU / kg body weight every 4 hours or 20, 000 -hour continuous lU/m2/24 .
3 . Contraindications
Bleeding disorders , hemorrhagic stroke, bleeding at various sites (except those in embolic renal infarction or lungs) , bacterial eidokardit , severe disturbances of the kidneys and liver, leukemia , aplastic anemia , acute growing aneurysm of the heart.
4 . Special precautions for use
Caution should be used with heparin in ulcerative and tumor disabled pa stomach and intestines, cachexia, hypertension with blood pressure higher than 180/90 mm Hg ( 24/12 kPa).
Heparin should not be mixed in vitro with other drugs because of the possibility of physico- chemical incompatibilities.
Heparin does not have fibrinolytic activity and therefore it does not dissolve existing clots.
Heparin should be injected intramuscularly with the risk of hematoma formation !
During the treatment with heparin should be carried out and angiographies organ biopsies. Patients on heparin therapy (more than 22 500 UI/24 h) must not be put at risk of injury.
The presence of pregnancy or menstruation is not a contraindication for heparin therapy .
In the event of an overdose of the anticoagulant effect of heparin is neutralized by slow infusion of protamin sulfat ( which is its antagonist ) in the form of a 3% solution . Should be infused no more than 50 mg protamin sulfat, very slowly ( over 10 min). Each milligram protamin sulfat neutralizes approximately 100 UI heparin. Necessary amount of heparin decreases with time because antikogulantat metabolised. Under the influence of protamin sulfat half-life of heparin is shortened to about 30 min. It should be borne in mind that the application of protamin sulfat can cause severe hypotensive and anaphylactoid ADRs .
5 . Interactions
Drugs such as salicylates , non-steroidal anti-inflammatory drugs , dipyridamole , dextran, hydroxychloroquine , etc. . Which affect platelet aggregation (primary hemostatic defense in heparinized patients) may induce bleeding and must be administered with caution to patients treated with heparin sodium.
Digitalis , tetracyclines , nicotine or antihistamines may partially counteract the anticoagulant action of heparin sodium.
When changing to oral anticoagulants such as warfarin or acenocoumarol, they can be applied in reduction of heparin dose and under strict laboratory control .
Interactions with laboratory tests : Significant increases in the values of the aminotransferase (SGOT, SGPT) were observed in a large percentage of patients treated with heparin sodium.
6 . Use during pregnancy and lactation
Pregnancy Risk Category : C
Heparin sodium should be used during pregnancy only if certain indications. Complications due to maternal administration of heparin during pregnancy include hemorrhage , and osteoporosis . Heparin does not cross the placental barrier.
Heparin sodium is not excreted in breast milk in humans.
7 . Effects on ability to drive and use machines
No effect on ability to drive and use machines.
8 . Undesirable effects
Hematuria , bleeding , allergic reactions .
Heparin antagonist is protamin sulfat, which was injected intravenously ( 1 mg protamin sulfat inactivates 100 UI heparin). Caution should be used heparin sodium in ulcerative tumor and damage to the stomach and intestines , cachexia, hypertension with blood pressure higher than 180/90 .
In i.v. introducing in lower dose heparin has t ½ 1,5 h, in a greater than 3 to 5 h. His Vd is very low (0,058 L / kg), due to high affinity for plasma proteins.
3.2 . Pharmacodynamic properties:
Pharmacotherapeutic group: Anticoagulants ;