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Heparin (Unfractionated)

Classification

High Alert medicationAnticoagulant

Indications

PCFP/ACFP/CCP: Venous thromboembolism

PCFP/ACFP/CCP: Atrial fibrillation

PCFP/ACFP/CCP: Acute coronary syndromes

CCP: Extracorporeal membrane oxygenation (ECMO)

Contraindications

Active bleeding
Allergy to porcine products or any portion of the drug
History of heparin induced thrombocytopenia
Some products contain benzyl alcohol as a preservative; their use in neonates, infants, or pregnant or breastfeeding women is contraindicated by some manufacturers.

Adult dosages

Refer to site specific heparin nomograms as dosing recommendations can vary

PCFP/ACFP/CCP: Venous Thromboembolism

Loading dose:
- 80 units/kg/dose IV to a max of 5000 units
Maintenance:
- 12-18 units/kg/hour to maintain a PTT 1.5-2.5 times normal
PCFP/ACFP:☎️ CCP-A consultation required

PCFP/ACFP/CCP: Acute Coronary Syndromes

Loading dose: 60 units/kg IV to a max of 5000 units
Maintenance: 12 units/kg/hour IV infusion to maintain PTT 1.5-2.5 times normal
PCFP/ACFP:☎️ CCP-A consultation required

CCP: ECMO

Follow site specific guidelines

Pediatric Considerations And Dosing

Always consult heparin protocol in BCCH Pediatric Drug Dosage Guidelines

PCFP/ACFP/CCP: Thrombosis

All pediatric patients
- Loading dose:
  - 75 units/kg IV over 10 minutes
- Maintenance infusion
  - Less than 1 year: 28 units/kg/h
  - Greater than 1 year: 20 units/kg/h

PCFP/ACFP: ☎️ CCP-A consultation required

CCP: ECMO

Follow site specific protocol

Preparation and Administration

Standard Adult Concentration

100 units/mL

Obtain premixed bag from sending facility

How Supplied

Infusion premix Bag:

25,000 in 250mL of D5W

Maintenance of line patency:

5000 units/0.5mL vial

Mechanism Of Action

Heparin potentiates the action of antithrombin III and thereby inactivates thrombin (as well as other coagulation factors IXa, Xa, XIa, XIIa, and plasmin). This inactivation then prevents the conversion of fibrinogen to fibrin. Heparin also stimulates the release of lipoprotein lipase (lipoprotein lipase hydrolyzes triglycerides to glycerol and free fatty acids).

Pharmacokinetics

Onset: IV immediate, SC 20-30 minutes

Half-life: 1.5 hours

Adverse Effects

Hyperkalemia
Hemorrhage ranging from minor to major and can occur in any body system
Heparin induced thrombocytopenia
Hypersensitivity reactions
Fever
Rigors
Injection site necrosis
Neonatal gasping syndrome (benzyl alcohol-containing forms)

Overdose

Discontinue the Heparin infusion.
Administer Protamine Sulfate if necessary.

Warning And Precautions

Use in caution with elderly patients who are at higher risk of bleeding
Use with caution in patients with an increased risk of bleeding as fatal bleeding events may occur
High dose requirements ( greater than 35,000 in 24 hours) can occur in a variety of clinical circumstances but should be monitored closely

Drug Interactions

Anticoagulants: (low molecular weight heparin, rivaroxaban, dabigatran, apixaban, edoxaban.