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| Heparin, UFH, Unfractionated heparin Description Heparin is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans having anticoagulant properties. Action anticoagulant, blood-thinner Indications Heparin Sodium Injection, USP is indicated for: * Anticoagulant therapy in prophylaxis and treatment of venous thrombosis and its extension. * In a low-dose regimen for prevention of post-operative deep venous thrombosis and pulmonary embolism in patients undergoing major abdomino-thoracic surgery or who for other reasons are at risk of developing thromboembolic disease (see DOSAGE AND ADMINISTRATION). * Prophylaxis and treatment of pulmonary embolism. * Atrial fibrillation with embolization. * Diagnosis and treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation). * Prevention of clotting in arterial and cardiac surgery. * Prophylaxis and treatment of peripheral arterial embolism. * As an anticoagulant in blood transfusions, extracorporeal circulation, dialysis procedures and in blood samples for laboratory purposes. Side Effects bleeding, hematuria, hyperkalemia, injection site reaction, intraocular hemorrhage, osteoporosis, peripheral neuropathy, skin necrosis, thrombocytopenia, white-clot syndrome, Hemorrhage Hemorrhage is the chief complication that may result from heparin sodium therapy (see WARNINGS). An overly prolonged clotting time or minor bleeding during therapy can usually be controlled by withdrawing the drug (see OVERDOSAGE). It should be appreciated that gastrointestinal or urinary tract bleeding during anticoagulant therapy may indicate the presence of an underlying occult lesion. Bleeding can occur at any site but certain specific hemorrhagic complications may be difficult to detect: (a) Adrenal hemorrhage, with resultant acute adrenal insufficiency, has occurred during anticoagulant therapy. Therefore, such treatment should be discontinued in patients who develop signs and symptoms of acute adrenal hemorrhage and insufficiency. Initiation of corrective therapy should not depend on laboratory confirmation of the diagnosis, since delay in an acute situation may result in the patient's death. (b) Ovarian (corpus luteum) hemorrhage developed in a number of women of reproductive age a receiving short- or long- term anticoagulant therapy. This complication, if unrecognized, may be fatal. (c) Retroperitoneal hemorrhage. Local Irritation Local irritation, erythema, mild pain, hematoma or ulceration may follow deep subcutaneous (intrafat) injection of heparin sodium. These complications are much more common after intramuscular use, and such use is not recommended. Hypersensitivity Generalized hypersensitivity reactions have been reported, with chills, fever and urticaria as the most usual manifestations, and asthma, rhinitis, lacrimation, headache, nausea and vomiting, and anaphylactoid reactions, including shock, occurring more rarely. Itching and burning, especially on the plantar site of the feet, may occur. Thrombocytopenia has been reported to occur in patients receiving heparin sodium with a reported incidence of 0 to 30%. While often mild and of no obvious clinical significance, such thrombocytopenia can be accompanied by severe thromboembolic complications such as skin necrosis, gangrene of the extremities that may lead to amputation, myocardial infarction, pulmonay embolism, stroke and possibly death.( See WARNINGS and PRECAUTIONS.) Certain episodes of painful, ischemic and cyanosed limbs have in the past been attributed to allergic vasospastic reactions. Whether these are in fact identical to the thrombocytopenia-associated complications remains to be determined. Miscellaneous Osteoporosis following long-term administration of high-doses of heparin sodium, cutaneous necrosis after systemic administration, suppression of aldosterone synthesis, delayed transient alopecia, priapism and rebound hyperlipemia on discontinuation of heparin sodium have also been reported. Significant evaluations of aminotransferase (SGOT [S-AST] and SGPT [S-ALT]) levels have occurred in a high percentage of patients (and healthy subjects) who have received heparin sodium. Drug-Vitamin-Herb Interactions Negative interactions: Garlic Garlic is natural blood thinner, which may cause excessive thinning of the blood. Monitor PT and INR regularly. Ginkgo biloba Ginkgo is natural blood thinner, which may cause excessive thinning of the blood. Monitor PT and INR regularly. Phosphatidylserine Phosphatidylserine may enhance heparinÕs blood-thinning effects. Policosanol Policosanol could potentiate the actions of heparin, possibly causing excessive blood thinning. Vitamin C Test tube studies show high doses of vitamin C may reduce the blood-thinning effects of heparin. White willow White willow contains a substance converted into aspirin which can cause excess blood thinning. Natural blood thinners: Chamomile, Coleus, Dan shen, DevilÕs claw, Dong guai, Feverfew, Ginger, romelain, papain, fish oils, OPCs, vitamin E, Horse chestnut, Red clover, Reshi Natural blood thinners may cause excessive thinning of the blood. Monitor PT and INR regularly. Bromelain Bromelain may increase the risk of abnormal bleeding Positive interactions: Vitamin D Heparin may interfere with vitamin D metabolism, potentially causing osteoporosis.
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