HEPARIN SODIUM 2,000 UNITS AND SODIUM CHLORIDE 0.9% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Anticoagulant: binds to antithrombin III, enhancing its inhibition of factor Xa and thrombin; also inactivates factors IX, XI, XII, and plasmin.
| Metabolism | Primarily cleared by the reticuloendothelial system; partially metabolized by desulfation and depolymerization; renal excretion of metabolites. |
| Excretion | Renal: 50-60% as unchanged drug via urine; reticuloendothelial system: significant hepatic and splenic uptake with depolymerization; biliary: minor. Total clearance is dose-dependent due to saturable cellular binding. |
| Half-life | Terminal half-life: 1.5-2.5 hours (mean 1.7 h) for IV heparin; dose-dependent, increasing with higher doses (saturable clearance). In patients with renal impairment, half-life prolonged (up to 2-3 times). |
| Protein binding | Heparin binds to multiple plasma proteins: antithrombin III (ATIII) primarily (functional binding), but also to lipoproteins, histidine-rich glycoprotein, and platelet factor 4. Total protein binding: >90% (nonspecific binding). |
| Volume of Distribution | 0.05-0.07 L/kg (confined to plasma volume; ~5 L in 70 kg adult). Does not distribute into extravascular spaces. Increased Vd in pregnancy and obesity. |
| Bioavailability | Subcutaneous: 20-30% (due to poor absorption, tissue binding, and first-pass degradation). IV: 100%. Not absorbed orally. |
| Onset of Action | IV: immediate (within minutes). Subcutaneous: 20-30 minutes (peak at 2-4 hours). |
| Duration of Action | IV: 2-6 hours (dose-dependent; 2 h for 2,500 U, up to 6 h for high doses). Subcutaneous: 8-12 hours. Duration prolonged in renal/hepatic impairment. |
| Molecular Weight | 12000 |
Continuous IV infusion: 12-18 units/kg/hour, adjusted based on aPTT. Initial bolus of 60-80 units/kg may be given. Typical infusion rate for prophylaxis: 5,000 units subcutaneously every 8-12 hours.
| Dosage form | INJECTABLE |
| Renal impairment | Not required; heparin is not renally cleared. However, monitor aPTT closely in patients with severe renal impairment (eGFR < 30 mL/min) due to increased bleeding risk. |
| Liver impairment | Not recommended in severe hepatic impairment (Child-Pugh C) due to increased bleeding risk. In moderate impairment (Child-Pugh B), use with caution and monitor aPTT closely. |
| Pediatric use | Loading dose: 75-100 units/kg IV over 10 minutes. Maintenance: Infants: 28 units/kg/hour; Children: 18-20 units/kg/hour; Adolescents: 18 units/kg/hour. Adjust to target aPTT. |
| Geriatric use | Lower initial infusion rate (e.g., 10-12 units/kg/hour) due to increased sensitivity; monitor aPTT closely and reduce dose accordingly. Avoid subcutaneous if frail due to hematoma risk. |
| 1st trimester | Heparin does not cross the placenta; no known teratogenic effects. Can be used throughout pregnancy for anticoagulation. |
| 2nd trimester | Safe for use; no fetal risk due to high molecular weight and inability to cross placenta. |
| 3rd trimester | Safe for use; avoid spinal/epidural anesthesia if on heparin due to bleeding risk. Risk of maternal hemorrhage. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Does not cross the placenta due to high molecular weight and negative charge. |
| Breastfeeding | Heparin is not excreted into breast milk due to its high molecular weight and polarity; considered compatible with breastfeeding. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Heparin does not cross the placenta and is not teratogenic; no known fetal risk in any trimester. |
| Fetal Monitoring | Monitor maternal platelet count, signs of bleeding, and anti-Xa levels if needed; fetal monitoring as per routine obstetrical care. |
| Fertility Effects | No known negative effects on fertility. |
■ FDA Black Box Warning
Spinal/epidural hematomas have occurred with neuraxial anesthesia or spinal puncture; monitor for signs of neurological impairment.
| Common Effects | fluid replacement |
| Serious Effects |
Hypersensitivity to heparin or pork productsActive major bleedingThrombocytopenia (e.g., heparin-induced thrombocytopenia)Inability to perform appropriate monitoring (e.g., aPTT)Concomitant use of spinal/epidural anesthesia (risk of spinal hematoma)
| Precautions | Risk of hemorrhage: monitor coagulation tests (aPTT, anti-Xa) and platelet counts, Heparin-induced thrombocytopenia (HIT): discontinue if HIT suspected, Hypersensitivity reactions: can cause anaphylaxis, Hyperkalemia: may suppress aldosterone, monitor potassium in renal impairment |
| Food/Dietary | No significant food interactions. Maintain adequate hydration and a balanced diet. Avoid excessive alcohol consumption as it may increase bleeding risk. |
| Clinical Pearls | Administer via continuous IV infusion using an infusion pump; do not give IM. Monitor aPTT 6 hours after initiation and adjust dose per nomogram. For prophylaxis, subcutaneous injection is preferred. Use with caution in patients with thrombocytopenia or history of HIT. Protamine sulfate is the reversal agent. |
| Patient Advice | Report any signs of bleeding: unusual bruising, dark stools, blood in urine, bleeding gums. · Avoid aspirin, NSAIDs, and other blood thinners unless prescribed. · Inform all healthcare providers that you are on heparin. · Do not stop or change the dose without consulting your doctor. · If you miss a dose, contact your healthcare provider immediately. |
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