HEPARIN

Heparin received its initial FDA approval on 12 June 1939. It was among the first anticoagulant medications approved by the United States Food and Drug Administration for clinical use.

Heparin is used to prevent and treat blood clots in conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and during certain medical procedures and surgeries.

Heparin is administered intravenously (IV) or subcutaneously (under the skin). The specific dosage and administration method depends on the medical condition being treated, the patient's weight, age, and other factors, which a healthcare professional should determine. For IV use, this medication is usually given in a hospital setting under continuous monitoring to adjust the dosage as needed. Subcutaneous injections are often used for prophylactic purposes or in outpatient settings.

Heparin may cause several side effects, including both common and serious reactions. Common side effects include bruising, hematomas (blood collections under the skin), pain at the injection site, and elevated liver enzyme levels. Serious side effects encompass bleeding, which can manifest as unusual bruising, bleeding gums, nosebleeds, blood in urine or stool, and prolonged bleeding from cuts.

Serious bleeding complications can occur, such as gastrointestinal bleeding, intracranial bleeding (bleeding within the skull), or bleeding in other organs. HIT is a rare but potentially severe immune reaction that can occur in some patients treated with heparin. It leads to a significant decrease in platelet count and an increased risk of blood clotting (thrombosis). This medication use in patients undergoing spinal or epidural anesthesia or puncture can lead to the formation of a hematoma (blood clot) in or around the spine. This can cause pressure on the spinal cord, resulting in long-term or permanent paralysis. Elderly and frail patients may be more susceptible to the side effects of heparin, particularly bleeding complications.

Patients receiving heparin should be closely monitored for signs of bleeding, such as unusual bruising, bleeding from gums or nose, blood in urine or stool, and prolonged bleeding from cuts. If HIT is suspected, this medication should be discontinued immediately, and alternative anticoagulation should be initiated. Special caution is required in patients receiving heparin and regional anesthesia, and the procedure should be performed only if the benefits outweigh the risks. Close monitoring and appropriate dosage adjustments are essential in the elderly population.

Patients with bleeding disorders, liver or kidney problems, recent surgeries, or known allergies should inform their healthcare provider before starting heparin, as this information affects dosage and administration method selection. Blood clotting parameters, including activated partial thromboplastin time (aPTT) or anti-Xa assay, require regular monitoring to ensure the anticoagulant effect remains therapeutic and to prevent bleeding or thrombosis. Prescribed dosage and administration instructions must be followed precisely, and any unusual bleeding, bruising, or allergic reactions should be reported to the healthcare provider without delay. Activities or medications that may increase bleeding risk should be avoided during heparin therapy. Patients who adhere to treatment instructions and maintain regular communication with their healthcare provider can effectively minimise risks and optimise therapeutic outcomes.

Wockhardt UK Ltd, Electronic medicines compendium (EMC), [Revised on June 2018] [ Accessed on 30th July 2023], https://www.medicines.org.uk/emc/files/pil.1678.pdf Baxter Healthcare Corporation, US Food, and Drug Administration, [Accessed on 30th July 2023], https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/017037s158lbl.pdf KD Tripathi, Essentials of Medical Pharmacology, Drugs affecting coagulation, bleeding, and thrombosis, 7th edition, 2013, 617