DRUG STUDY
Generic Name heparin Therapeutic Class Anticoagulants
Brand Name Heparin Pharmacologic Class Anticoagulants
Dosage, Frequency and Route of For Adults For Pediatric Use
Administration There are no adequate and well-controlled studies on
heparin use in pediatric patients. Pediatric dosing recommendations
are based on clinical experience. In general, the following dosage
schedule may be used as a guideline in pediatric patients:
Initial Dose: 75 to 100 units/kg (intravenous bolus over 10 minutes)
Maintenance Dose Infants: 25 to 30 units/kg/hour; Infants < 2
months have the highest requirements (average 28 units/kg/hour)
Children > 1 year of age: 18 to 20 units/kg/hour; Older children may
require less heparin, similar to weight-adjusted adult dosage
Monitoring: Adjust heparin to maintain aPTT of 60 to 85 seconds,
assuming this reflects an anti-Factor Xa level of 0.35 to 0.70.
Under normal circumstances, antithrombin III (ATIII) inactivates thrombin (factor IIa) and factor Xa. This process occurs at a
slow rate. Administered heparin binds reversibly to ATIII and leads to almost instantaneous inactivation of factors IIa and Xa The
heparin-ATIII complex can also inactivate factors IX, XI, XII and plasmin. The mechanism of action of heparin is ATIII-dependent. It
Mechanism of Action acts mainly by accelerating the rate of the neutralization of certain activated coagulation factors by antithrombin, but other
mechanisms may also be involved. The antithrombotic effect of heparin is well correlated to the inhibition of factor Xa. Heparin is not a
thrombolytic or fibrinolytic. It prevents progression of existing clots by inhibiting further clotting. The lysis of existing clots relies on
endogenous thrombolytics.
Thromboprophylaxis
Indications Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE)
Embolism associated with atrial fibrillation.
Easy bleeding and bruising Itching of the feet
Pain Bluish-colored skin.
Side Effects
Redness, warmth, irritation or skin changes where the medicine Fever
was injected.
Bleeding or haemorrhage Heparin-induced thrombocytopenia
Thrombosis Hyperkalemia
Adverse Reactions
Transient alopecia Hypoaldosteronism
Osteoporosis Anaphylactic reactions
Hypersensitivity to heparin Recent surgery to brain, eye or spinal cord
Contraindications Previous HIT Severe HTN and Active Bleeding
Bleeding Disorder Alcoholics
Monitor for bleeding
Check color of urine, occult blood in stool, and/or changes in vital signs.
Patients with history of peptic ulcer disease, alcoholism, kidney or liver disease and the elderly are at greatest risk for bleeding.
Nursing Considerations
Monitor PTT for therapeutic values (1 ½ - 2 ½) baseline.
Encourage smoking cessation. (Nicotine decreases the effect of heparin. Patient should not smoke while on heparin therapy.)
Monitor CBC in female patients who are menstruating. ( Anticoagulation may cause excessive blood loss during menses.)
