Heparins systemic

Author:Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Certoparin-Na; Dalteparin sodium; Reviparin sodium; Tinzaparin sodium

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DefinitionThis section has been translated automatically.

Direct acting anticoagulants.

Pharmacodynamics (Effect)This section has been translated automatically.

Cofactor of antithrombin III, increases the inhibitory effect on prothrombin activation and thrombin, thus preventing the conversion of fibrinogen into fibrin. Inhibition of platelet aggregation, inhibition of coagulation factors XII, IX and V, defence against allergic and anaphylactic reactions.

IndicationThis section has been translated automatically.

Thrombosis prophylaxis, locally for thrombosis, bruising, thrombophlebitis, erythema nodosum.

Limited indicationThis section has been translated automatically.

Chron. Alcoholism, chronic inflammatory bowel disease, endocarditis lenta, limb injuries, hypertension, severe liver or kidney dysfunction, polytrauma.

Dosage and method of useThis section has been translated automatically.

Thrombosis prophylaxis: see table 1.
Thrombosis and embolism: Weight-adapted full heparinisation with low-molecular-weight heparin e.g. Nadroparin (Fraxiparin) 2 times/day 0.1 ml/10 kg KG s.c.
Only in exceptional cases unfractionated heparin 5,000 IU i.v. in bolus. over 5 min: 25,000 IU in 50 ml NaCl 0.9% over perfusor 2.8 ml/hour (= 1,400 IU/hour), control of the PTT after 6 hours and dose adjustment according to the PTT quotient:

PTT: > 7: interruption of the infusion for one hour, dose reduction by 500 IU/hr
PTT: 5.1-7: reduction by 500 IU/hr
PTT: 4.1-5: Reduction by 300 IU/hr
PTT: 3.1-4: reduction by 100 IU/hr
PTT: 2.6-3: Reduction of 50 IU/hr.
PTT: 1.5-2.5: No dose change required
PTT: 1.2-1.4: Increase by 200 IU/hour
PTT: < 1.2: Increase by 400 IU/hour

Notice! After dose adjustment, repeat PTT determination after 10 h. If the PTT quotient is > 5 before dose change, more frequent checks, e.g. every 4 h, are required!

Undesirable effectsThis section has been translated automatically.

Bleeding into parenchymatous organs, thrombocytopenia (less common with low molecular weight heparins), allergic reactions, hair loss, osteoporosis, gastrointestinal disorders.

InteractionsThis section has been translated automatically.

See Table 2.

ContraindicationThis section has been translated automatically.

Hypersensitivity to the active substance, abortus imminens, tendency to bleed, lumbar, peridual and spinal anaesthesia, CNS and eye operations, apoplexy.

Note(s)This section has been translated automatically.

Remember! Treatment of bleeding complications: In case of lighter bleedings administration of 5-10 mg vitamin K p.o.; in case of life-threatening bleedings administration of protamine chloride (e.g. protamine ICN).

After i.v. injection of heparin: 1 amp. Protamine ICN 1000 IU/ml i.v. (depending on the severity of the case, repeat once or several times at intervals of a few minutes).
After subcutaneous application of heparin: 1 amp. Protamine ICN 1000 IU/ml i.v. (to inactivate the heparin in the bloodstream; 1 ml protamine neutralizes about 1000 IU heparin). Then 1 amp. Protamine ICN 5000 deep i.v. (to inactivate the depot resulting from the subcutaneous injection). Repeat if necessary!

Remember! In cases of heparin-induced thrombocytopenia or heparin intolerance (HIT), systemic heparinoids such as Danaparoid (Organon), pentasaccharides such as Fondaparinux (Arixtra) or the prostacyclin derivative iloprost (ilomedin) may be used as substitutes!

PatientinformationThis section has been translated automatically.

Remember! Patients with bleeding tendency may only be treated with heparins under special precautions. All patients with heparin side effects should receive a passport or allergy pass in which the side effect is noted!

LiteratureThis section has been translated automatically.

Trautmann A (2006) Heparin allergy: Late type allergy to subcutaneous heparin injection. Allergo J 15: 501-506

TablesThis section has been translated automatically.

Overview of important heparins

	Active substance	HWZ	Dosage Thrombosis prophylaxis			Preparations
			Medium risk	High risk	Full heparinization
Unfractionated, conventional heparins	Heparin	Two hours.	3 times/day 5000 IE s.c. or 2 times/day 7500 IE s.c.	PTT-adapted therapy with up to 3 times/day 7500 IU s.c.	PTT-adapted therapy: Initial bolus with 80 IU/kg bw or 5000 IU i.v., then 18 IU/kg bw/hour i.v.	Liquemin
Unfractionated, conventional heparins	Heparin	Two hours.	3 times/day 5000 IE s.c. or 2 times/day 7500 IE s.c.	PTT-adapted therapy with up to 3 times/day 7500 IU s.c.	Heparin resistance (exclusion of AT deficiency!) if no PTT prolongation is achieved after administration of 40.000 IE/24 hrs.	Liquemin

Low molecular weight heparins	Certoparin-Na	100-180 minutes.	once/day 3000 IE s.c.	once/day 3000 IU s.c.	2 times/day 8000 IU s.c.	Mono-Embolex NM
	Dalteparin-Na		once/day 2500 IE s.c.	once/day 5000 IU s.c.	once/day 200 IU/kg cw s.c. or twice/day 100 IU/kg cw s.c.	Fragmin
	Enoxaparin-Na		once/day 2000-3000 IE s.c.	once/day 4000 IU to twice/day 3000 IU s.c.	once/day 200 IU/kg bw s.c. or twice/day 1 mg/kg bw s.c.	Clexane
	Nadroparin-Ca		once/day 2850 IE s.c.	weight adapted 2 times/day 0.1 ml/10 kg KG s.c.	weight-adapted twice a day 0.1 ml/10 kg KG s.c. or twice a day 87.5 IU/kg KG s.c.	Fraxiparin
	Reviparin-Na		once/day 2850 IE s.c.	once/day 4200 IU s.c.	2 times/day 87,5 IU/kg KG s.c.	Clivarin
	Tinzaparin-Na		once/day 3500 IE s.c.	once/day 4500 IE s.c. or weight-adapted 50 IE/kg KG s.c.	once/day 175 IU/kg KG s.c.	Innohep

Essential interactions of heparins in systemic application

Alcohol	Bleeding tendency ↑
Anticoagulants, oral	Bleeding tendency ↑
Cephalosporins	Bleeding tendency ↑
Dapson	Bleeding tendency ↑
Dextran	Bleeding tendency ↑
Dipyridamole	Bleeding tendency ↑
Fibrinolytics	Bleeding tendency ↑
Glycerol trinitrate i.v.	Heparin resistance
Deep-sea fish oil	Bleeding tendency ↑
Mucopolysaccharide polysulfate	Cross Allergy
NSAID	Bleeding tendency ↑
Penicillin i.v.	Bleeding tendency ↑
Pentoxifylline	Bleeding tendency ↑
Propanolol	Propanolol levels ↑
Propylene glycol	Heparin resistance
Cytostatics	Bleeding tendency ↑

Authors

Last updated on: 29.10.2020

Author: Prof. Dr. med. Peter Altmeyer