II. Mechanism

  1. Potentiates Antithrombin III (AT III)
  2. See Intrinsic Clotting Pathway

III. Dosing: Prophylactic for DVT Prevention

  1. Heparin 5000 Units SQ every 8-12 hours

IV. Dosing: Therapeutic Dosing by Weight based Calculations

  1. Measure
    1. Total body weight (TBW) in kilograms
    2. Height in inches
  2. Calculate Lean Body Weight (LBW) in kilograms
    1. Male: 50 + 2.3 x (height in inches - 60)
    2. Female: 45 + 2.3 x (height in inches -60)
  3. Calculate Dosing Weight
    1. Non-Obese
      1. Dosing Weight (kg): TBW above
    2. Obese (TBW > 1.4 x LBW)
      1. Dosing Weight (kg): (0.4 x TBW) + LBW
  4. Calculate Heparin starting doses
    1. Bolus: 80 Units/kg
      1. Maximum: 10,000 units
      2. Round to nearest 100 units
    2. Maintenance: 18 Units/kg/hour
      1. Round to nearest 50 units per hour

V. Labs: Therapeutic Dosing Initial (before Heparin)

VI. Labs: Therapeutic Dosing Recurring Labs

  1. Partial Thromboplastin Time (aPTT)
    1. 6 hours after bolus and then per nomogram
  2. Platelets
    1. Every 3 days
    2. Minimum: 150,000

VII. Protocol: Therapeutic Dosing Nomogram

  1. aPTT under 40
    1. Give 6000 unit bolus
    2. Increase maintenance rate by 6 units/kg/hour
    3. Recheck aPTT in 6 hours
  2. aPTT 40-49
    1. Give 3000 unit bolus
    2. Increase maintenance rate by 4 units/kg/hour
    3. Recheck aPTT in 6 hours
  3. aPTT 50-59
    1. Give 1500 unit bolus
    2. Increase maintenance rate by 2 units/kg/hour
    3. Recheck aPTT in 6 hours
  4. aPTT 60-85
    1. No change in dosing
    2. Recheck aPTT on the next morning
  5. aPTT 86-100
    1. Decrease maintenance rate by 1 unit/kg/hour
    2. Recheck aPTT in 6 hours
  6. aPTT over 100
    1. Stop Heparin for 60 minutes
    2. Decrease maintenance rate by 2 units/kg/hour
    3. Recheck aPTT in 6 hours

VIII. Adverse Effects

  1. Bleeding complications
  2. Heparin Induced Thrombocytopenia

IX. Management: Reversal

Images: Related links to external sites (from Google)

Cost: Medications

Heparin Sodium (Porcine) (on 2/9/2012 at DrugStore.com)
Heparin Sodium (Porcine) 1000unit/ml Solution 10ml Vial #1 for $188.99 ($188.99/unit)
Heparin Sodium (Porcine) 10000unit/ml Solution 1ml Vial #25 for $259.20 ($10.37/unit)
Heparin Sodium (Porcine) 10000unit/ml Solution 5ml Vial #1 for $29.99 ($29.99/unit)

Ontology: Heparin (C0019134)

Definition (NCI) A sulfur-rich glycosaminoglycan with anticoagulant property. Heparin binds to antithrombin III to form a heparin-antithrombin III complex. The complex binds to and irreversibly inactivates thrombin and other activated clotting factors, such as factors IX, X, XI, and XII, thereby preventing the polymerization of fibrinogen to fibrin and the subsequent formation of clots.
Definition (NCI) A substance that slows the formation of blood clots. Heparin is made by the liver, lungs, and other tissues in the body and can also made in the laboratory. Heparin may be injected into muscle or blood to prevent or break up blood clots. It is a type of anticoagulant.
Definition (SPN) Enzyme preparations are products that are used in the histopathology laboratory for the following purposes: (1) To disaggregate tissues and cells already in established cultures for preparation into subsequent cultures (e.g., trypsin); (2) To disaggregate fluid specimens for cytological examination (e.g., papain for gastric lavage or trypsin for sputum liquefaction); (3) To aid in the selective staining of tissue specimens (e.g., diastase for glycogen determination).
Definition (MSH) A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts.
Definition (CSP) poly(glucosamine sulfate-glucuronic acid); endogenous mucopolysaccharide with antithrombin and lipotropic activities; USP injection is used as an anticoagulant.
Concepts Carbohydrate (T118) , Pharmacologic Substance(T121) , Biologically Active Substance(T123)
MSH D006493
SnomedCT 372877000, 84812008, 96382006
English Heparin, Heparinic Acid, heparin, Heparin preparation, heparin preparations (medication), heparin preparations, Heparin [Chemical/Ingredient], Heparin.unfractionated, Heparin, Unfractionated, Unfractionated Heparin, unfractionated heparin, heparin unfractionated, heparins, Unfractionated heparin, Heparin (product), Heparin (substance), Unfractionated heparin (substance), HEPARIN
Swedish Heparin
Czech heparin
Finnish Hepariini
Italian Acido eparinico, Eparina
Russian GEPARIN, AL'FA-GEPARIN, GEPARINOVAIA KISLOTA, АЛЬФА-ГЕПАРИН, ГЕПАРИН, ГЕПАРИНОВАЯ КИСЛОТА
Japanese α-ヘパリン, ヘパリン, アルファヘパリン
Croatian HEPARIN
Polish Heparyna
Spanish heparina (producto), heparina (sustancia), heparina no fraccionada (sustancia), heparina no fraccionada, heparina, Acido Heparinico, Heparina, Ácido Heparínico
French Héparine
German Heparin, Heparinsäure
Portuguese Ácido Heparínico, Heparina