G-Heparin

• Approved Indications:
• Prevention and treatment of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Prophylaxis of thromboembolic complications in patients undergoing surgery, particularly orthopedic and cardiac surgery.
• Treatment of acute coronary syndromes (unstable angina, non-ST elevation myocardial infarction [NSTEMI], ST-elevation myocardial infarction [STEMI]) as adjunctive therapy.
• Anticoagulation during extracorporeal circulation (e.g., hemodialysis, cardiopulmonary bypass).
• Prevention of clot formation in central venous catheters and arterial lines.
• Clinically Accepted Off-Label Uses:
• Treatment of disseminated intravascular coagulation (DIC) in selected cases.
• Adjunct in percutaneous coronary interventions (PCI).
• Prevention of clotting in extracorporeal membrane oxygenation (ECMO).

রেজিস্টার্ড চিকিৎসকের নির্দেশনা অনুযায়ী ঔষধ সেবন করুন।

1. Prevention of Venous Thromboembolism (VTE)

·         Adults:

o    Subcutaneous (SC): 5,000 IU every 8–12 hours, starting 2 hours before surgery or as per protocol.

o    Intravenous (IV): 5,000 IU bolus followed by 1,000–2,000 IU/hour continuous infusion, or 5,000–10,000 IU every 4–6 hours.

·         Children: 250 IU/kg SC every 12 hours.

·         Elderly: Initiate at lower doses with close monitoring.

2. Treatment of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

·         Adults:

o    IV Loading Dose: 5,000 IU bolus.

o    Continuous Infusion: 1,000 IU/hour, adjusted based on activated partial thromboplastin time (aPTT).

·         Children: 50–100 IU/kg IV bolus, followed by 400–600 IU/kg/day continuous infusion.

·         Monitoring: Adjust infusion to maintain aPTT within the therapeutic range (usually 1.5–2.5 times the control value).

3. Acute Coronary Syndromes (ACS)

·         ST-Elevation Myocardial Infarction (STEMI):

o    IV Bolus: 60–70 IU/kg (maximum 5,000 IU).

o    Continuous Infusion: 12–15 IU/kg/hour (maximum 1,000 IU/hour).

·         Non-ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina:

o    IV Bolus: 60–70 IU/kg (maximum 5,000 IU).

o    Continuous Infusion: 12–15 IU/kg/hour (maximum 1,000 IU/hour).

·         Monitoring: Adjust infusion to maintain aPTT within the therapeutic range.

4. Extracorporeal Circulation (e.g., Hemodialysis, Cardiopulmonary Bypass)

·         Hemodialysis:

o    Initial Dose: 25–30 IU/kg IV bolus.

o    Maintenance Infusion: 1,500–2,000 IU/hour.

·         Cardiopulmonary Bypass: Dosage is individualized based on patient and circuit characteristics; continuous monitoring of aPTT is recommended.

5. Pediatric Dosing

·         Neonates and Infants:

o    IV Loading Dose: 75–100 IU/kg.

o    Continuous Infusion: 28 IU/kg/hour for infants under 2 months; 20 IU/kg/hour for children over 1 year.

·         Monitoring: Frequent monitoring of aPTT is essential to adjust dosing appropriately.

6. Renal and Hepatic Impairment

·         Renal Impairment: Heparin is primarily cleared by the liver; however, in severe renal impairment, dosing adjustments may be necessary.

·         Hepatic Impairment: Use with caution; monitor for signs of bleeding and adjust dosing as needed.

7. Special Considerations

·         Pregnancy: Heparin does not cross the placenta and is considered safe during pregnancy.

·         Breastfeeding: Heparin is excreted in breast milk in negligible amounts and is considered safe during breastfeeding.

·         Elderly: Initiate therapy at lower doses with close monitoring due to increased risk of bleeding.

রেজিস্টার্ড চিকিৎসকের নির্দেশনা অনুযায়ী ঔষধ সেবন করুন।

Heparin sodium is an anticoagulant that enhances the activity of antithrombin III (ATIII), a natural inhibitor of several coagulation enzymes. By binding to ATIII, heparin accelerates its ability to inactivate thrombin (factor IIa), factor Xa, and other activated clotting factors, thereby preventing conversion of fibrinogen to fibrin and inhibiting clot formation. This effect leads to decreased blood clot formation and propagation, reducing the risk of thrombosis.

• Absorption:
• Poorly absorbed orally; administered parenterally.
• SC absorption is variable and slower than IV.
• Distribution:
• Rapidly binds to plasma proteins and endothelial cells.
• Volume of distribution approximates blood volume.
• Metabolism:
• Metabolized by the reticuloendothelial system and liver.
• Excretion:
• Primarily eliminated via the kidneys.
• Half-life varies with dose; approximately 1–2 hours after IV administration.
• Onset of Action:
• IV: Immediate.
• SC: 20–60 minutes.

• Pregnancy: FDA Category C. Use only if clearly needed. Does not cross the placenta significantly.
• Lactation: Considered compatible with breastfeeding as it is not orally absorbed and has minimal systemic absorption by the infant.
• Data: Limited controlled studies in pregnancy; benefits must outweigh risks.

• Primary Class: Anticoagulant
• Subclass: Indirect thrombin inhibitor; unfractionated heparin

• Known hypersensitivity to heparin or pork products.
• History of heparin-induced thrombocytopenia (HIT).
• Active major bleeding or high risk of bleeding.
• Severe thrombocytopenia unrelated to heparin.
• Severe uncontrolled hypertension.
• Recent or impending surgery of the eye, brain, or spinal cord.

• Monitor for bleeding complications, especially gastrointestinal, intracranial, or retroperitoneal bleeding.
• Heparin-induced thrombocytopenia (HIT) is a serious immune-mediated reaction; monitor platelet counts regularly.
• Use with caution in patients with bleeding disorders, recent surgery, or severe liver/kidney disease.
• Monitor aPTT or anti-Xa levels to guide dosing and minimize bleeding risk.
• Abrupt discontinuation may increase thrombosis risk.
• Use cautiously in elderly due to higher bleeding risk.

• Common:
• Bleeding and bruising.
• Injection site reactions (pain, erythema).
• Thrombocytopenia (including HIT).
• Serious/Rare:
• Heparin-induced thrombocytopenia (HIT) with or without thrombosis.
• Hemorrhage (intracranial, gastrointestinal, retroperitoneal).
• Hyperkalemia due to aldosterone suppression.
• Osteoporosis with long-term use.

• Increased bleeding risk with:
• Other anticoagulants (warfarin, direct oral anticoagulants).
• Antiplatelet agents (aspirin, clopidogrel).
• NSAIDs and thrombolytics.
• Reduced efficacy with protamine sulfate (antidote).
• Drugs affecting platelet function may potentiate bleeding risk.
• No significant CYP450 enzyme interactions as heparin is not metabolized by these pathways.

• Guidelines emphasize careful monitoring of aPTT or anti-Xa levels for dose adjustment.
• HIT screening recommended for patients with platelet count drop >50% during heparin therapy.
• Preference for low molecular weight heparins (LMWH) or direct oral anticoagulants in many indications, but unfractionated heparin remains important in renal impairment and certain procedural settings.
• Updated protocols recommend minimizing heparin use duration to reduce bleeding and HIT risks.

• Store at controlled room temperature, 20°C to 25°C (68°F to 77°F).
• Protect from light and freezing.
• Keep vial tightly closed when not in use.
• Use aseptic technique to avoid contamination.