LIQUAEMIN SODIUM PRESERVATIVE FREE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for LIQUAEMIN SODIUM PRESERVATIVE FREE (LIQUAEMIN SODIUM PRESERVATIVE FREE).
Heparin binds to antithrombin III, accelerating its inhibition of coagulation factors IIa (thrombin) and Xa, thereby preventing thrombus formation and extension.
| Metabolism | Heparin is primarily metabolized by the liver via desulfation and depolymerization; renal clearance of inactive metabolites also occurs. |
| Excretion | Renal: 50-70% as unchanged heparin and metabolites via saturable clearance; biliary/fecal: <5% as metabolites. |
| Half-life | Terminal elimination half-life: 1-2 hours (0.5-1.5 h at therapeutic doses, dose-dependent due to saturable clearance). Context: shorter half-life in pulmonary embolism, prolonged in hepatic/renal impairment. Protamine reversal used for rapid offset. |
| Protein binding | High: ~90-95%, primarily to antithrombin III, with secondary binding to albumin, fibrinogen, and histidine-rich glycoprotein. |
| Volume of Distribution | 0.05-0.07 L/kg (confined to plasma volume; low Vd due to high protein binding and large molecular size). |
| Bioavailability | SubQ: 20-30% (due to binding to endothelial cells and macrophages at injection site). IV: 100%. |
| Onset of Action | IV: Immediate (within 2-3 minutes). SubQ: 20-60 minutes (delay due to absorption lag). |
| Duration of Action | IV: 2-6 hours (dose-dependent). SubQ: 8-12 hours. Notes: Duration prolonged with higher doses; monitoring aPTT required. |
Intravenous: Initial bolus of 80 units/kg followed by continuous infusion at 18 units/kg/hour; subcutaneous: 5000 units every 8-12 hours.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl <30 mL/min: reduce dose by 50% and monitor anti-Xa levels; CrCl 30-60 mL/min: reduce dose by 25%; no adjustment for CrCl >60 mL/min. |
| Liver impairment | Child-Pugh Class B or C: reduce initial dose by 50% and monitor anti-Xa; no data for Class A, use with caution. |
| Pediatric use | Intravenous: 75-100 units/kg bolus, then 20-25 units/kg/hour infusion; subcutaneous: 250 units/kg every 12 hours. Adjust to maintain aPTT 1.5-2.5 times control. |
| Geriatric use | Patients >60 years: reduced clearance; lower initial bolus (60 units/kg) and infusion rate (15 units/kg/hour); monitor aPTT and anti-Xa closely. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for LIQUAEMIN SODIUM PRESERVATIVE FREE (LIQUAEMIN SODIUM PRESERVATIVE FREE).
| Breastfeeding | Heparin is not excreted into breast milk due to high molecular weight and polarity. Considered compatible with breastfeeding. M/P ratio not applicable. |
| Teratogenic Risk | Heparin does not cross the placenta. No evidence of teratogenicity in first trimester. Use during second and third trimesters is generally considered safe, but risk of maternal hemorrhage and fetal bleeding exists peripartum. |
| Fetal Monitoring |
■ FDA Black Box Warning
Heparin is contraindicated in patients with a history of heparin-induced thrombocytopenia (HIT) or known hypersensitivity to heparin. Use with extreme caution in patients with major bleeding risk.
| Serious Effects |
["Active major bleeding","History of heparin-induced thrombocytopenia (HIT) or HIT with thrombosis","Known hypersensitivity to heparin or pork products","Severe thrombocytopenia","Uncontrolled bleeding disorders (e.g., hemophilia)"]
| Precautions | ["Risk of hemorrhage: monitor for signs of bleeding, especially at surgical sites","Heparin-induced thrombocytopenia (HIT): monitor platelet counts regularly","Allergic reactions: may cause hypersensitivity including anaphylaxis","Osteoporosis with long-term use (greater than 6 months)","Hyperkalemia due to suppression of aldosterone","Use with caution in renal impairment and liver disease"] |
| Food/Dietary | No direct food interactions; however, foods rich in vitamin K (e.g., leafy greens) do not significantly alter heparin efficacy, but maintain consistent intake if on warfarin transition. |
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| Monitor maternal platelet count (risk of heparin-induced thrombocytopenia), signs of bleeding (epistaxis, bruising, hematuria), and anti-Xa levels if adjusted-dose heparin used. Fetal surveillance per obstetric indication. |
| Fertility Effects | No known adverse effects on fertility. Heparin does not affect gametogenesis or implantation. |
| Clinical Pearls | Liquaemin (heparin sodium) is a parenteral anticoagulant; monitor aPTT closely (goal 1.5-2.5x baseline). Protamine sulfate is the reversal agent. Avoid intramuscular injection due to hematoma risk. Use with caution in renal impairment. Heparin-induced thrombocytopenia (HIT) is a serious adverse effect; check platelet counts regularly. |
| Patient Advice | Report any unusual bleeding or bruising immediately. · Avoid aspirin, NSAIDs, and other anticoagulants unless prescribed. · Inform all healthcare providers you are on heparin. · Do not take any new medications without consulting your doctor. · Use electric razor and soft toothbrush to minimize bleeding risk. |