Unfractionated heparin: Difference between revisions

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==Common Indications==
==General==
*Type: [[Anticoagulant]]
*Dosage Forms: IV, SC
*Common Trade Names: Heparin


==Adult Dosing==
===Thromboembolism===
*Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
*Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
*Adjust dose to target aPTT levels based on nomogram


DVT, PE, AFIB, ACS
===Acute Coronary Syndrome===
*Bolus: 50 units/kg IV x 1 (MAX: 5,000 units)
*Then drip: 12 units/kg/h IV (MAX: 1,000 units/h)
*Adjust dose to target aPTT levels based on nomogram


==Pediatric Dosing==
*IV infusion
**Initial loading dose 75 units/kg given over 10 minutes
**Initial maintenance dose 20 units/kg/hour and adjest per local policy


==Bleeding Risk Factors==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
*Renal Dosing
**No adjustment
*Hepatic Dosing
**No adjustment


==Contraindications==
*Allergy to class/drug
*33% of patients develop some form of bleeding complication; 2-6% develop major bleeding
*[[HIT (Heparin-Induced Thrombocytopenia)]]


A. Surgery, trauma, or stroke within the previous 14 days.
===Risk Factors for Major Bleeding Complication===
*Recent surgery or trauma
*Renal failure
*Alcoholism
*Malignancy
*Liver failure
*Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs


B. History of peptic ulcer disease, GI bleeding or GU bleeding.
==Adverse Reactions==
===Serious===
*Major bleeding
*Thrombocytopenia


C. Platelet count less than 150K
===Common===
*Injection site reaction<ref>Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/</ref>
*Hyperkalemia
*Alopecia
*Osteoporosis


D. Age > 70 yrs.
==Pharmacology==
*Half-life: 1.5 hrs
*Metabolism: Hepatic
*Excretion: Urine
*Mechanism of Action:
**Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
*Anticoagulation effect lasts up to 3hr after stopping infusion
*Must give IV (not subq) for acute thromboembolic disease
**Unpredictable anticoagulation effect
**Must monitor with PTT; therapeutic range is 1.5-2.5x normal value


E. Hepatic failure, uremia, bleeding diathesis, brain metastases.


==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''


*Draw extra blue top prior to starting if concerned about a hypercoaguable state (heparin will interfere with assays)
{{#ask:[[Has DrugName::Unfractionated heparin]]
|?Has Indication=Indication
|?Has Dose=Dose
|?Has Context=Context
|?Has Route=Route
|?Has Population=Population
|format=table
|headers=plain
|mainlabel=-
|sort=Has Indication
|limit=50
}}


==See Also==
*[[Unfractionated heparin reversal]]
*[[Coagulopathy (main)]]
*[[Low molecular weight heparin]]


==Treatment ==
==References==
<references/>


 
[[Category:Pharmacology]]
A. Bolus - 150 u/kg for PE, and 80-100 u/kg for all other conditions.
 
B. Infuse - 15-25 u/kg/hr (high risk --> 15-18 u/kg/hr; low risk --> 22-25 u/kg/hr)
 
 
C. Sliding scale - PTT in 60-80 range..
 
PTT Bolus/Hold Adjust Heparin
 
<50 70 u/kg 0 Increase 200 u/hr
 
50-59 0 0 Increase 100 u/hr
 
60-80 0 0 No change
 
81-99 0 0 Decrease 100u/hr
 
>100 0 60min Decrease 200 u/hr
 
 
*If 1st PTT after loading dose is > 100 sec do NOT change the infusion rate unless evidence of bleeding
 
 
D. The PTT should be checked 4-6 hrs after a new bolus or any change in the infusion dose.
 
E. Other LABS to check include stool GUIAC qd and CBC (platelets) qd
 
 
Duration: DVT or PE --> 5 days of heparin (even if the INR is therapeutic earlier in hospital course)
 
 
==Source ==
 
 
1/22/06; DONALDSON (addapted from Lampe)
 
 
 
 
[[Category:Heme/Onc]]

Latest revision as of 21:55, 20 March 2026

General

  • Type: Anticoagulant
  • Dosage Forms: IV, SC
  • Common Trade Names: Heparin

Adult Dosing

Thromboembolism

  • Bolus: 80 units/kg IV x 1 (MAX: 5,000 units)
  • Then drip: 18 units/kg/h IV (MAX: 1,000 units/h)
  • Adjust dose to target aPTT levels based on nomogram

Acute Coronary Syndrome

  • Bolus: 50 units/kg IV x 1 (MAX: 5,000 units)
  • Then drip: 12 units/kg/h IV (MAX: 1,000 units/h)
  • Adjust dose to target aPTT levels based on nomogram

Pediatric Dosing

  • IV infusion
    • Initial loading dose 75 units/kg given over 10 minutes
    • Initial maintenance dose 20 units/kg/hour and adjest per local policy

Special Populations

Contraindications

Risk Factors for Major Bleeding Complication

  • Recent surgery or trauma
  • Renal failure
  • Alcoholism
  • Malignancy
  • Liver failure
  • Concurrent use of warfarin, fibrinolytics, steroids, or antiplatelet drugs

Adverse Reactions

Serious

  • Major bleeding
  • Thrombocytopenia

Common

  • Injection site reaction[1]
  • Hyperkalemia
  • Alopecia
  • Osteoporosis

Pharmacology

  • Half-life: 1.5 hrs
  • Metabolism: Hepatic
  • Excretion: Urine
  • Mechanism of Action:
    • Binds to and activates antithrombin which in turns inactivates factor Xa and thrombin
  • Anticoagulation effect lasts up to 3hr after stopping infusion
  • Must give IV (not subq) for acute thromboembolic disease
    • Unpredictable anticoagulation effect
    • Must monitor with PTT; therapeutic range is 1.5-2.5x normal value


Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

IndicationDoseContextRoutePopulation
Acute arterial ischemia80 units/kg bolus, then 18 units/kg/hr infusionAnticoagulation to prevent clot propagationIVAdult
Non-ST-elevation myocardial infarction60-70 units/kg bolus (max 5000), then 12-15 units/kg/hr (max 1000/hr)Antithrombotic; consider if PCI/CABG within 24hr or renal failureIVAdult
Pulmonary embolism80 units/kg IV bolus, then 18 units/kg/hr continuous infusionAnticoagulation (preferred if rapid reversal needed)IV dripAdult
ST-segment elevation myocardial infarction60 units/kg IV bolus (max 4000 U), then 12 units/kg/hr (max 1000 U/hr); titrate to PTT 1.5-2.5x controlAnticoagulation (required with thrombolytics/PCI)IV dripAdult
Unstable angina60 units/kg IV bolus (max 4000 units), then 12 units/kg/hr (max 1000 units/hr)AntithromboticIVAdult

See Also

References

  1. ↑ Warnock LB, Huang D. Heparin. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538247/
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