Diferencia entre revisiones de «Unfractionated heparin»

Sin resumen de edición
(Switch SMW query from broadtable to table format for better layout with TOC)
 
(No se muestran 40 ediciones intermedias de 11 usuarios)
Línea 1: Línea 1:
==Common Indications==
==General==
DVT, PE, AFIB, ACS
*Type: [[Anticoagulant]]
*Dosage Forms: IV, SC
*Common Trade Names: Heparin


==Bleeding Risk Factors==
==Adult Dosing==
# Surgery, trauma, or stroke within the previous 14 days.
===Thromboembolism===
# History of peptic ulcer disease, GI bleeding or GU bleeding.
*Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
# Platelet count less than 150K
*Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
# Age > 70 yrs.
*Adjust dose to target aPTT levels based on nomogram
# Hepatic failure, uremia, bleeding diathesis, brain metastases.


Draw extra blue top prior to starting if concerned about a hypercoaguable state (heparin will interfere with assays)
===Acute Coronary Syndrome===
*Bolus: 50 units/kg IV x 1 (MAX: 5,000 units)
*Then drip: 12 units/kg/h IV (MAX: 1,000 units/h)
*Adjust dose to target aPTT levels based on nomogram


==Treatment ==
==Pediatric Dosing==
# Bolus - 150 u/kg for PE, and 80-100 u/kg for all other conditions.
*IV infusion
# Infuse - 15-25 u/kg/hr (high risk --> 15-18 u/kg/hr; low risk --> 22-25 u/kg/hr)
**Initial loading dose 75 units/kg given over 10 minutes
# Sliding scale - PTT in 60-80 range..
**Initial maintenance dose 20 units/kg/hour and adjest per local policy
##PTT Bolus/Hold Adjust Heparin
##<50 70 u/kg 0 Increase 200 u/hr
##50-59 0 0 Increase 100 u/hr
##60-80 0 0 No change
##81-99 0 0 Decrease 100u/hr
##>100 0 60min Decrease 200 u/hr
###If 1st PTT after loading dose is > 100 sec do NOT change the infusion rate unless evidence of bleeding
# The PTT should be checked 4-6 hrs after a new bolus or any change in the infusion dose.
# Other LABS to check include stool GUIAC qd and CBC (platelets) qd


Duration: DVT or PE --> 5 days of heparin (even if the INR is therapeutic earlier in hospital course)
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
*Renal Dosing
**No adjustment
*Hepatic Dosing
**No adjustment


==Source ==
==Contraindications==
1/22/06; DONALDSON (addapted from Lampe)
*Allergy to class/drug
*33% of patients develop some form of bleeding complication; 2-6% develop major bleeding
*[[HIT (Heparin-Induced Thrombocytopenia)]]


[[Category:Heme/Onc]]
===Risk Factors for Major Bleeding Complication===
*Recent surgery or trauma
*Renal failure
*Alcoholism
*Malignancy
*Liver failure
*Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs
 
==Adverse Reactions==
===Serious===
*Major bleeding
*Thrombocytopenia
 
===Common===
*Injection site reaction<ref>Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/</ref>
*Hyperkalemia
*Alopecia
*Osteoporosis
 
==Pharmacology==
*Half-life: 1.5 hrs
*Metabolism: Hepatic
*Excretion: Urine
*Mechanism of Action:
**Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
*Anticoagulation effect lasts up to 3hr after stopping infusion
*Must give IV (not subq) for acute thromboembolic disease
**Unpredictable anticoagulation effect
**Must monitor with PTT; therapeutic range is 1.5-2.5x normal value
 
 
==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''
 
{{#ask:[[Has DrugName::Unfractionated heparin]]
|?Has Indication=Indication
|?Has Dose=Dose
|?Has Context=Context
|?Has Route=Route
|?Has Population=Population
|format=table
|headers=plain
|mainlabel=-
|sort=Has Indication
|limit=50
}}
 
==See Also==
*[[Unfractionated heparin reversal]]
*[[Coagulopathy (main)]]
*[[Low molecular weight heparin]]
 
==References==
<references/>
 
[[Category:Pharmacology]]

Revisión actual - 21:55 20 mar 2026

General

  • Type: Anticoagulant
  • Dosage Forms: IV, SC
  • Common Trade Names: Heparin

Adult Dosing

Thromboembolism

  • Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
  • Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
  • Adjust dose to target aPTT levels based on nomogram

Acute Coronary Syndrome

  • Bolus: 50 units/kg IV x 1 (MAX: 5,000 units)
  • Then drip: 12 units/kg/h IV (MAX: 1,000 units/h)
  • Adjust dose to target aPTT levels based on nomogram

Pediatric Dosing

  • IV infusion
    • Initial loading dose 75 units/kg given over 10 minutes
    • Initial maintenance dose 20 units/kg/hour and adjest per local policy

Special Populations

Contraindications

Risk Factors for Major Bleeding Complication

  • Recent surgery or trauma
  • Renal failure
  • Alcoholism
  • Malignancy
  • Liver failure
  • Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs

Adverse Reactions

Serious

  • Major bleeding
  • Thrombocytopenia

Common

  • Injection site reaction[1]
  • Hyperkalemia
  • Alopecia
  • Osteoporosis

Pharmacology

  • Half-life: 1.5 hrs
  • Metabolism: Hepatic
  • Excretion: Urine
  • Mechanism of Action:
    • Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
  • Anticoagulation effect lasts up to 3hr after stopping infusion
  • Must give IV (not subq) for acute thromboembolic disease
    • Unpredictable anticoagulation effect
    • Must monitor with PTT; therapeutic range is 1.5-2.5x normal value


Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

IndicationDoseContextRoutePopulation
Acute arterial ischemia80 units/kg bolus, then 18 units/kg/hr infusionAnticoagulation to prevent clot propagationIVAdult
Non-ST-elevation myocardial infarction60-70 units/kg bolus (max 5000), then 12-15 units/kg/hr (max 1000/hr)Antithrombotic; consider if PCI/CABG within 24hr or renal failureIVAdult
Pulmonary embolism80 units/kg IV bolus, then 18 units/kg/hr continuous infusionAnticoagulation (preferred if rapid reversal needed)IV dripAdult
ST-segment elevation myocardial infarction60 units/kg IV bolus (max 4000 U), then 12 units/kg/hr (max 1000 U/hr); titrate to PTT 1.5-2.5x controlAnticoagulation (required with thrombolytics/PCI)IV dripAdult
Unstable angina60 units/kg IV bolus (max 4000 units), then 12 units/kg/hr (max 1000 units/hr)AntithromboticIVAdult

See Also

References

  1. ↑ Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/
Obtenido de «https://www.wikem.org/w/index.php?title=Unfractionated_heparin&oldid=387399»