Uses of Diparin: - Blood clots Atrial fibrillation, Acute coronary syndrome, Unstable angina, Pulmonary embolism, Thromboembolism, Deep-vein thrombosis, Cardiopulmonary bypass, Hemofiltration, Peripheral arterial embolism Patients predisposed to active bleeding including thrombocytopenia, peptic ulcer disease, cerebrovascular disorders, haemorrhagic blood disorders, bacterial endocarditis, severe hypertension, oesophageal varices. Recent surgery at sites where haemorrhage would be an especial risk. Severe renal and hepatic impairment. Cerebral or subarachnoid haemorrhage, abdominal or thoracic bleeding into closed space, severe traumatic bleed, hepatic, renal, splenic or arterial injury, severe haemostatic defect, arterial thrombosis with heparin-associated thrombocytopenia. IM admin.

Parenteral anti-coagulants

Heparin inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both in vitro and in vivo. Heparin acts at multiple sites in the normal coagulation system. Small amounts of heparin in combination with antithrombin III (heparin cofactor) can inhibit thrombosis by inactivating activated Factor X and inhibiting the conversion of prothrombin to thrombin. Once active thrombosis has developed, larger amounts of heparin can inhibit further coagulation by inactivating thrombin and preventing the conversion of fibrinogen to fibrin. Heparin also prevents the formation of a stable fibrin clot in inhibiting the activation of the fibrin stabilizing factor.Bleeding time is usually unaffected by heparin. Clotting time is prolonged by full therapeutic doses of heparin; in most cases, it is not measurably affected by low doses of heparin.

How to use Heparin Sodium: Your doctor or nurse will give you this medicine. Kindly do not self administer. Administration: IV Preparation Recommended infusion concentration for most patients is 25,000 units in 500 mL D5W (50 units/mL premixed infusion solution) IV Administration IV injection may be given undiluted or diluted in 50-100 mL NS or D5W Infusion: Dilute in NS, D5W, or other compatible fluid Continuous IV therapy is preferred because intermittent IV therapy produces a higher incidence of bleeding abnormalities Adult Dose: DVT & Pulmonary Embolism Prophylaxis 5000 units Subcutaneous(SC) q8-12hr, OR 7500 units SC q12hr Treatment 80 units/kg IV bolus, THEN continuous infusion of 18 units/kg/hr, OR 5000 units IV bolus, THEN continuous infusion of 1300 units/hr, OR 250 units/kg (alternatively, 17,500 units) SC, THEN 250 units/kg q12hr Acute Coronary Syndromes PCI Without GPIIb/IIIa inhibitor: Initial IV bolus of 70-100 units/kg (target ACT 250-300 sec) With GPIIb/IIIa inhibitor: Initial IV bolus of 50-70 units/kg (target ACT >200 sec) STEMI Patient on fibrinolytics: IV bolus of 60 units/kg (max: 4000 units), THEN 12 units/kg/hr (max 1000 units/hr) as continuous IV infusion Dose should be adjusted to maintain aPTT of 50-70 sec Unstable Angina/NSTEMI Initial IV bolus of 60-70 units/kg (max: 5000 units), THEN initial IV infusion of 12-15 units/kg/hr (max: 1000 units/hr) Dose should be adjusted to maintain aPTT of 50-70 sec Anticoagulation Intermittent IV injection 8000-10,000 units IV initially, THEN 50-70 units/kg (5000-10,000 units) q4-6hr Continuous IV infusion 5000 units IV injection, followed by continuous IV infusion of 20,000-40,000 units/24 hr Catheter Patency Prevention of clot formation within venous and arterial catheters Use 100 units/mL; instill enough volume to fill lumen of catheter Child Dose: Venous Thromboembolic Prophylaxis 100-150 units/kg IV once Venous Thromboembolic Treatment <1 year Loading dose of 75 units/kg IV, THEN 28 units/kg/hr IV as initial maintenance dose >1 year Loading dose of 75 units/kg IV, THEN 20 units/kg/hr IV as initial maintenance dose I ntermittent IV injection Initially give 50-100 units/kg IV infusion, THEN 100 units/kg IV infusion q4hr as a maintenance dose

Enhanced anticoagulant effect w/ other drugs affecting platelet function or the coagulation system (e.g. platelet aggregation inhibitors, thrombolytic agents, salicylates, NSAIDs, vit K antagonists, dextrans, activated protein C). Decreased anticoagulant effect w/ gyceryl trinitrate infusion. Increased risk of hyperkalaemia w/ ACE inhibitors or angiotensin II antagonists.

Patients predisposed to active bleeding including thrombocytopenia, peptic ulcer disease, cerebrovascular disorders, haemorrhagic blood disorders, bacterial endocarditis, severe hypertension, oesophageal varices. Recent surgery at sites where haemorrhage would be an especial risk. Severe renal and hepatic impairment. Cerebral or subarachnoid haemorrhage, abdominal or thoracic bleeding into closed space, severe traumatic bleed, hepatic, renal, splenic or arterial injury, severe haemostatic defect, arterial thrombosis with heparin-associated thrombocytopenia. IM admin.

>10% Heparin-induced thrombocytopenia, possibly delayed (10-30% ) Frequency Not Defined Mild pain,Hematoma,Hemorrhage,Local irritation,Erythema,Injection site ulcer (after deep SC injection),Increased liver aminotransferase,Anaphylaxis,Immune hypersensitivity reaction,Osteoporosis (long-term, high-dose use) Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis; bleeding.

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.Nursing Mothers: Due to its large molecular weight, heparin is not likely to be excreted in human milk, and any heparin in milk would not be orally absorbed by a nursing infant. Benzyl alcohol present in maternal serum is likely to cross into human milk and may be orally absorbed by a nursing infant. Exercise caution when administering Heparin Sodium Injection to a nursing mother.

Precaution: Monitor platelet counts. Discontinue treatment if thrombocytopenia occurs. Hypersensitivity, elderly, pregnancy. Lactation: Not excreted in breast milk; compatible

Symptoms: Bleeding (nose bleeds, blood in urine or tarry stools may be noted as the 1st sign of bleeding). Management: May give protamine sulfate by slow IV infusion over 10 min to treat severe bleeding (1 mg of protamine sulfate neutralises approx 100 U of heparin). Max: 50 mg as a single dose.

Store between 20-25° C. Protect from freezing.

Parenteral anti-coagulants

Heparin increases the inhibitory action of antithrombin III (AT III) on clotting factors XIIa, XIa, IXa, Xa and thrombin. This inhibits the conversion of prothrombin to thrombin and fibrinogen to fibrin. It also inhibits platelet function. It may reduce the activity of ATIII at very high doses.

Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.Nursing Mothers: Due to its large molecular weight, heparin is not likely to be excreted in human milk, and any heparin in milk would not be orally absorbed by a nursing infant. Benzyl alcohol present in maternal serum is likely to cross into human milk and may be orally absorbed by a nursing infant. Exercise caution when administering Heparin Sodium Injection to a nursing mother.