Heparin Drug: Uses, Mechanism, Side Effects, Nursing Responsibilities

Heparin🩸 

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1. Introduction

• Heparin is a naturally occurring anticoagulant (blood thinner).

• It is used to prevent and treat blood clots in veins, arteries, or lungs.

• Heparin does not dissolve clots but prevents their growth and formation of new clots.

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2. Classification

Category	Details
Pharmacological	Indirect thrombin inhibitor
Therapeutic	Anticoagulant
Source	Extracted from animal tissues (porcine intestinal mucosa or bovine lung)

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3. Mechanism of Action (MOA)

• Heparin binds to antithrombin III (AT III).

• This enhances AT III's ability to inactivate thrombin (factor IIa) and factor Xa.

• As a result:

  • Inhibits conversion of fibrinogen to fibrin.

  • Prevents the formation and propagation of clots.

🧠 Mnemonic: "Heparin Helps Antithrombin Halt Clotting"

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4. Types of Heparin

Type	Details
Unfractionated Heparin (UFH)	Standard form, IV or SC administration
Low Molecular Weight Heparin (LMWH)	e.g., Enoxaparin (Lovenox), Dalteparin
Synthetic Pentasaccharide	e.g., Fondaparinux (selective Xa inhibitor)

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5. Routes of Administration

Route	Use
IV infusion/bolus	For immediate anticoagulation (hospital setting)
SC injection	For prophylaxis or ongoing treatment

❌ Not given IM – risk of hematoma formation
❌ Not given orally – not absorbed in GI tract

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6. Indications

🩺 Therapeutic Use:

• Deep Vein Thrombosis (DVT)

• Pulmonary Embolism (PE)

• Acute Coronary Syndrome (ACS): MI, unstable angina

• Atrial Fibrillation (AF) with risk of embolism

• During cardiac surgeries (e.g., CABG)

• Dialysis and blood transfusion procedures

🛡 Prophylactic Use:

• Post-surgical patients (e.g., orthopedic surgeries)

• Bedridden patients at risk for thrombosis

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7. Dosage

• IV bolus: 5000–10000 units, followed by continuous infusion.

• SC prophylaxis: 5000 units SC every 8–12 hours.

• Adjusted based on: aPTT levels (Activated Partial Thromboplastin Time).

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8. Monitoring Parameters

Parameter	Normal Range	Therapeutic Range
aPTT	25–35 seconds	1.5–2.5× baseline (usually 45–70 seconds)
Platelet count	150,000–400,000/mm³	Monitor for HIT
Hematocrit, hemoglobin	Monitor for bleeding

LMWH (e.g., enoxaparin) usually does not require aPTT monitoring

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9. Side Effects

🚨 Common:

• Bleeding (gums, urine, stool, injection site)

• Bruising

⚠️ Serious:

• Heparin-Induced Thrombocytopenia (HIT) – immune-mediated platelet destruction

• Osteoporosis (long-term use)

• Hypersensitivity reactions

• Hyperkalemia (rare)

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10. Contraindications

• Active bleeding

• Severe thrombocytopenia (especially due to HIT)

• Hemophilia

• Intracranial hemorrhage

• Recent surgery (brain, eye, spinal cord)

• Severe hypertension

• Hypersensitivity to heparin or pork products

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11. Antidote

• Protamine sulfate

  • 1 mg of protamine neutralizes ~100 units of heparin.

  • Given IV slowly to avoid adverse reactions.

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12. Drug Interactions

Interacting Drug	Effect
Aspirin, NSAIDs	↑ bleeding risk
Warfarin	Additive anticoagulant effect
Thrombolytics	↑ risk of hemorrhage
Digoxin, tetracycline, nicotine	↓ heparin effect

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13. Nursing Responsibilities

Before Administration:

• Check baseline aPTT, CBC, platelet count.

• Assess for signs of bleeding or contraindications.

• Confirm correct dosage and route.

During Administration:

• Rotate injection sites (SC).

• Do not massage site or aspirate (↑ bruising).

• Monitor aPTT every 6 hours until stable, then daily.

• Watch for signs of bleeding: gums, nose, urine, stool, bruises.

• Observe for HIT: ↓ platelet count, new thrombosis.

Patient Education:

• Report any signs of bleeding or unusual bruising.

• Avoid aspirin or NSAIDs unless prescribed.

• Use soft toothbrush, electric razor.

• Avoid contact sports or injury.

• Do not stop medication abruptly.

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14. Heparin vs. Warfarin (Comparison Table)

Feature	Heparin	Warfarin
Onset	Immediate (IV)	3–5 days
Route	IV, SC	Oral
Monitoring	aPTT	INR (2–3 therapeutic range)
Pregnancy safety	Safe	Contraindicated
Antidote	Protamine sulfate	Vitamin K
Duration	Short (hours)	Long (days)
Use	Acute setting	Long-term anticoagulation

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15. Summary Mnemonic – "HEPARIN"

H – Hemorrhage (monitor bleeding)
E – Educate patient on signs of bleeding
P – Protamine sulfate (antidote)
A – aPTT monitoring
R – Rotate injection sites
I – Injection route: IV or SC only
N – No IM injections or NSAIDs