Drug Guide

Generic Name

Heparin Sodium

Brand Names Liquaemin Sodium, Liquaemin Lock Flush, Liquaemin Sodium Preservative Free, Panheprin, Heparin Lock Flush, Heparin Sodium Preservative Free, Lipo-hepin

Classification

Therapeutic: Anticoagulant

Pharmacological: Indirect thrombin inhibitor

FDA Approved Indications

Prevention and treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and other thromboembolic disorders
Prophylaxis during surgeries such as cardiopulmonary bypass

Mechanism of Action

Heparin enhances the activity of antithrombin III, which inhibits thrombin and factor Xa, leading to anticoagulation.

Dosage and Administration

Adult: Dosage varies based on indication; typical initial IV bolus 5,000 units, followed by continuous infusion titrated to activated partial thromboplastin time (aPTT)

Pediatric: Dosing based on body weight and clinical condition, often similar to adult adjustments

Geriatric: Use with caution, starting at lower doses due to increased bleeding risk

Renal Impairment: Adjust dose as needed; heparin clearance is affected by renal function

Hepatic Impairment: No specific adjustment; monitor closely

Pharmacokinetics

Absorption: Not applicable (administered parenterally)

Distribution: Bind to plasma proteins and endothelial cells

Metabolism: Metabolized by the reticuloendothelial system

Excretion: Primarily hepatic and reticuloendothelial system, minimal renal excretion

Half Life: Approximately 1 to 2 hours

Contraindications

Hypersensitivity to heparin or porcine origin products
Active bleeding, such as intracranial hemorrhage or hemophilia

Precautions

Use with caution in patients with bleeding disorders, recent surgery, or severe hypertension. Monitor closely for signs of bleeding and heparin-induced thrombocytopenia (HIT).

Adverse Reactions - Common

Bleeding (Common)
Heparin-induced thrombocytopenia (HIT) (Uncommon)

Adverse Reactions - Serious

Severe hemorrhage (Rare)
Osteoporosis (with prolonged use) (Rare)
Hypersensitivity reactions (Rare)

Drug-Drug Interactions

Other anticoagulants (warfarin, direct oral anticoagulants)
Antiplatelet agents (aspirin, clopidogrel)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor aPTT, platelet count, signs of bleeding, and hematoma formation

Diagnoses:

Risk for bleeding
Risk for bleeding related to anticoagulant therapy

Implementation: Administer IV or subcutaneously as prescribed, ensuring proper dosage and timing, monitor laboratory values and patient status regularly

Evaluation: Ensure therapeutic aPTT levels are maintained without excessive bleeding, adjust dosage as needed

Patient/Family Teaching

Report unusual bleeding, bruising, or pain immediately
Avoid NSAIDs and alcohol to reduce bleeding risk
Inform about signs of bleeding and thrombocytopenia

Special Considerations

Black Box Warnings:

Epidural or spinal hematoma risk with epidural anesthesia or spinal puncture

Genetic Factors: HIT associated with antibodies against heparin-platelet factor 4 complexes, which is immune-mediated

Lab Test Interference: Heparin can interfere with certain coagulation tests

Overdose Management

Signs/Symptoms: Profuse bleeding, hypotension, hematuria

Treatment: Discontinue heparin, administer protamine sulfate as an antidote, provide supportive care, and monitor coagulation parameters closely

Storage and Handling

Storage: Store at room temperature, protect from light and moisture

Stability: Stable until expiration date on the label when stored properly