HEPARIN SODIUM 2,000 UNITS AND SODIUM CHLORIDE 0.9% IN PLASTIC CONTAINER
Clinical safety rating: safe
No 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Heparin is not excreted into breast milk due to its high molecular weight; compatible with breastfeeding. M/P ratio: not applicable. |
| Teratogenic Risk | Heparin does not cross the placenta and is not teratogenic; no known fetal risk in any trimester. |
■ 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 |
["History of heparin-induced thrombocytopenia (HIT)","Active bleeding or bleeding disorders (e.g., hemophilia, thrombocytopenia)","Severe uncontrolled hypertension","Recent major surgery or trauma with high bleeding risk","Hypersensitivity to heparin or pork products"]
| 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"] |
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| 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. |