Heparin resistance refers to situations where unusually large doses of heparin are required to achieve anticoagulation. For weight-based IV heparin, an institution-specific dosing nomogram may help to achieve therapeutic anticoagulation more rapidly (see example based on aPTT under Venous thromboembolism treatment). SubQ: 5,000 to 7,500 units every 8 hours. When the risk of HIT is <1%, routine platelet count monitoring is not necessary (ACCP [Guyatt 2012]). Monitor therapy, Apixaban: May enhance the anticoagulant effect of Anticoagulants. Protect from freezing and temperatures >40°C. Using the wrong type of heparin to flush a catheter can result in fatal bleeding. Indication. However, a large retrospective cohort study suggests administration of 5,000 units every 8 hours results in similar venous thromboembolism rates for obese patients (BMI >30 kg/m2) compared to nonobese patients (Patanwala 2018). SubQ: Inject in subcutaneous tissue only (not muscle tissue). See the full edoxaban drug monograph for specific recommendations on switching anticoagulant treatment. [2020] IV: Initial bolus of 60 to 80 units/kg, followed by an initial continuous infusion of 12 to 18 units/kg/hour; adjust infusion rate to maintain anticoagulation target based on institutional protocol (ACCP [Garcia 2012]; Dager 2018; Hull 2019a). The SARS-CoV-2 IgG assay is intended for use as an aid in identifying individuals with an adaptive immune response to SARS-CoV-2, indicating recent or prior infection. • It is used to thin the blood so that clots will not form. Indication: Qualitative detection of IgG antibodies to SARS-CoV-2 in human serum and plasma (sodium heparin or dipotassium (K2) EDTA). In November 2020, this was an off‑label use of unfractionated heparin. A volume of at least 10 mL of blood should be removed and discarded from a heparinized line before blood samples are sent for coagulation testing. Monitor therapy, Tibolone: May enhance the anticoagulant effect of Anticoagulants. Monitor therapy, Angiotensin II Receptor Blockers: Heparin may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Transitioning from a therapeutic dose of IV heparin to a direct-acting oral anticoagulant: Start DOAC when the heparin infusion is stopped (consult local protocol if the aPTT is above the target range) (Dager 2018). • Elderly: Use with caution in patients >60 years of age, particularly women; older adults can be more sensitive to heparin and a higher incidence of bleeding has been reported in these patients. The recommendations for dosing in obese patients are based upon the best available evidence and clinical expertise. Monitor therapy, Ibrutinib: May enhance the adverse/toxic effect of Anticoagulants. Monitor therapy, Urokinase: May enhance the anticoagulant effect of Anticoagulants. Antibiotic lock solutions contain an appropriate antimicrobial and are usually mixed with heparin or NS at a sufficient volume to fill the catheter lumen. Monitor therapy, Tobacco (Smoked): May decrease the serum concentration of Heparin. Monitor therapy, MiFEPRIStone: May enhance the adverse/toxic effect of Anticoagulants. IV: Initial: 80 units/kg bolus followed by a continuous infusion of 18 units/kg/hour using adjusted body weight; adjust infusion rate to maintain target laboratory values based on institutional protocol (Barletta 2008; Hosch 2017; expert opinion). May restart ≥4 to 6 hours after vaginal delivery or ≥6 to 12 hours after cesarean delivery, unless significant bleeding occurred or traumatic neuraxial catheter placement. Monitor therapy, Desirudin: Anticoagulants may enhance the anticoagulant effect of Desirudin. Note: Until large prospective studies are available evaluating dosing and outcomes, it is reasonable to use 5,000 units every 8 hours. Intravesical (off-label use): Various dosage regimens of heparin (20,000 to 50,000 units) alone or with alkalinized lidocaine (1% to 4%) have been instilled into the bladder. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Institutional dosing protocols may vary; adjust infusion rate to maintain anticoagulation target (ACCP [Garcia 2012]; ACCP [You 2012]; Dager 2018). 37 - 42 Heparin is incompatible with ethanol and should not be used with ethanol lock therapy (Balestrino 2016; IDSA [Mermel 2009]). Clinical experience also suggests the utility of heparin for this use [Braun 2020], [Pearl 2020]. amlodipine, aspirin, lisinopril, metoprolol, carvedilol, clopidogrel, atenolol, Eliquis, propranolol, warfarin. However, increased blood volume is expected with increasing body weight, resulting in increased dosing requirements for obese patients (Estes 1980; Hirsh 1995). Monitor therapy, Pentosan Polysulfate Sodium: May enhance the anticoagulant effect of Anticoagulants. Instill into each lumen of the catheter access port using a sufficient volume to fill the catheter (eg, 2 to 5 mL) with a dwell time of ≤72 hours, depending on frequency of catheter use. Heparin should be stored at room temperature. Monitor therapy, Acalabrutinib: May enhance the anticoagulant effect of Anticoagulants. Do not use heparin injection to flush (clean out) an intravenous (IV) catheter. Monitor therapy, Collagenase (Systemic): Anticoagulants may enhance the adverse/toxic effect of Collagenase (Systemic). BMI ≥40 kg/m2: Note: A retrospective study using actual body weight for weight-based dosing showed greater aPTT values compared to nonmorbidly obese patients (Barletta 2008). Dose-dependent: IV bolus: 25 units/kg: 30 minutes (Bjornsson 1982); 100 units/kg: 60 minutes (de Swart 1982); 400 units/kg: 150 minutes (Olsson 1963). Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The half-life may be increased or decreased. Use in neonates, infants, or pregnant or nursing mothers is contraindicated by some manufacturers; the use of preservative-free heparin is, therefore, recommended in these populations. Note: The optimal duration of prophylaxis has not been established, but it is usually given for a minimum of 7 to 10 days; extending for up to 4 weeks may be reasonable in those undergoing major abdominal or pelvic surgery (ASCO [Key 2020]). Anti-Xa 0.1-0.29 units/mL:25 units/kg(maximum 2,500 units), Anti-Xa < 0.1 units/mL:50 units/kg(maximum 5,000 units), Guidelines for Reversal of Anticoagulation, Anticoagulation Around Invasive Procedures, Therapeutic Monitoring of Warfarin While on Bivalirudin, DOAC to Heparin Transition (HMC & UWMC-NW), Monitoring for Initial LMWH Therapy, Including Bridging, Simplified Nomogram for Warfarin Maintenance Dosing, Recommendations for Chronic Antithrombotic Therapy, Guidelines for Reversing Coagulopathies in Patients with Symptomatic Spontaneous IPH, Spontaneous IPH: Reversal Guide for DOACs, Spontaneous IPH: Reversal Guide for Warfarin, Guidelines for Reversal of Anticoagulants, UW - CT Surgery Perioperative Hemostasis Plan, Guidelines for the Use of Bivalirudin in HIT, Guidelines for the Use of Argatroban in HIT, Monitoring Direct Thrombin Inhibitors - DTI Assay, Risk Stratification and Recommendations for Bridge Therapy, Stroke Risk Assessment in Atrial Fibrillation (CHADS2/CHA2DS2-VASc), Suggestions for Anticoagulation Management, Patient Instruction Forms for Bridge Therapy, Anticoagulation Management Peri-Dental Procedures, Local Methods to Prevent or Control Bleeding, Management of Antithrombotic Therapy for Chronic Pain Procedures, Management of Antithrombotic Therapy for Neuraxial Procedures, Perioperative Management of Antiplatelet Therapy, Guidelines for Prevention of VTE in Hospitalized Patients. Select one or more newsletters to continue. Monitor therapy, Potassium-Sparing Diuretics: Heparin may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Dose intensity is individualized based on risk of thrombosis and bleeding complications (ACOG 196 2018; Bauer 2020). Monitor therapy, Vitamin K Antagonists (eg, warfarin): Anticoagulants may enhance the anticoagulant effect of Vitamin K Antagonists. Safety: Many concentrations of heparin are available ranging from 1 to 20,000 units/mL. Monitor therapy, Deoxycholic Acid: Anticoagulants may enhance the adverse/toxic effect of Deoxycholic Acid. Dose of heparin flush used should not approach therapeutic unit per kg dose. Management: Carefully weigh the prospective benefits of progestins against the potential increased risk of procoagulant effects and thromboembolism. ): May enhance the anticoagulant effect of Heparin. Monitor therapy, Nonsteroidal Anti-Inflammatory Agents: May enhance the anticoagulant effect of Heparin. If percutaneous coronary intervention occurs >12 hours after the last SubQ dose of enoxaparin: May use full-dose heparin; refer to recommendations above for PCI with no prior anticoagulant therapy (ACCF/AHA/SCAI [Levine 2011]). Senior Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC. Management: If heparin is used to maintain an intravenous line, rinse the line with saline prior to and after palifermin administration. Consider therapy modification, Prostacyclin Analogues: May enhance the adverse/toxic effect of Anticoagulants. Transitioning from a direct-acting oral anticoagulant to a therapeutic dose of IV heparin: Stop direct-acting oral anticoagulant (DOAC) and, when the next DOAC dose would have been due, start IV heparin without a bolus dose (infusion rate depends on the indication) (Dager 2018). 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS), 2011 American College of Cardiology Foundation/American Heart Association/Society for Cardiovascular Angiography and Interventions (ACCF/AHA/SCAI) guidelines for PCI, 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction (STEMI). SubQ: 5,000 units 2 to 4 hours prior to surgery, then 5,000 units every 8 hours thereafter (ASCO [Key 2020]) or 5,000 units every 8 to 12 hours started ~6 to 24 hours after surgery (Bauer 2019a). Thyroid stimulating hormone and standard competitive free thyroid hormone assays are not usually affected (Burch 2019). Low-molecular-weight heparin (LMWH) is a class of anticoagulant medications. • Hyperkalemia: Monitor for hyperkalemia; can cause hyperkalemia by suppressing aldosterone production. Also refer to section 4.4, Special warnings and precautions for use. Mean: 1.5 hours; Range: 1 to 2 hours; affected by obesity, renal function, malignancy, presence of pulmonary embolism, and infections. Monitor therapy, Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased. Alternatively, dosing based on actual body weight (without a bolus) may be considered with an initial reduced maintenance dose (eg, 12 units/kg/hour) (Gerlach 2013; expert opinion). If thrombolytics are used during inpatient treatment, some experts recommend discontinuing heparin during administration then resuming upon completion of the thrombolytic infusion (Tapson 2019). Pregnancy: Note: For patients at moderate or high VTE risk during antepartum and postpartum periods. SubQ: Initial: 333 units/kg, followed by 250 units/kg every 12 hours (ACCP [Guyatt 2012]; ACCP [Holbrook 2012]; Lip 2019). Monitor therapy, Oritavancin: May diminish the therapeutic effect of Heparin. Intracatheter: 100 to 5,000 units/mL in combination with an appropriate antibiotic. Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. Refer to separate drug interaction content and to full drug monograph content regarding use of apixaban with vitamin K antagonists (eg, warfarin, acenocoumarol) during anticoagulant transition and bridging periods. See NICE's information on prescribing medicines. It is also used before surgery to reduce the risk of blood clots. IV: Limited data available: Initial: 12 to 18 units/kg/hour (no bolus); adjust infusion rate to maintain anticoagulation target based on institutional protocol. Solution, Intravenous, as sodium [preservative free]: Generic: 10 units/mL (1 mL [DSC], 3 mL, 5 mL); 100 units/mL (1 mL [DSC], 3 mL, 5 mL). Carefully examine each prefilled syringe, bag, or vial prior to use to ensure that the correct concentration is chosen. Specifically, the risk of bleeding may be increased. For patients with end-stage renal disease requiring hemodialysis, maximum final heparin concentration should not exceed 1,000 units/mL due to increased risk of bleeding (Yevzlin 2007). Consult drug interactions database for more information. Monitor therapy, Limaprost: May enhance the adverse/toxic effect of Anticoagulants. See manufacturer's labeling. Percutaneous coronary intervention (off-label use): No planned glycoprotein IIb/IIIa inhibitor use: IV: Initial bolus of 70 to 100 units/kg (maximum: 10,000 units) to achieve activated clotting time (ACT) of 250 to 300 seconds (goal ACT may vary depending on point-of-care device); repeat bolus as needed to maintain goal ACT throughout procedure (ACCF/AHA [O’Gara 2013]; ACCF/AHA/SCAI [Levine 2011]; AHA/ACC [Amsterdam 2014]; Cutlip 2020). • It may be given to you for other reasons. IV: Initial: 80 units/kg bolus followed by a continuous infusion of 18 units/kg/hour using actual body weight; adjust infusion rate to maintain target laboratory values based on institutional protocol (Shlensky 2020). Monitor therapy, Obinutuzumab: Anticoagulants may enhance the adverse/toxic effect of Obinutuzumab. Monitor therapy, Angiotensin-Converting Enzyme Inhibitors: Heparin may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Heparin may be used for anticoagulation in pregnancy (ACOG 196 2018). Monitor therapy, Pentoxifylline: May enhance the anticoagulant effect of Heparin. Patients >60 years of age may have higher serum levels and clinical response (longer aPTTs) as compared to younger patients receiving similar dosages. Order standard heparin infusion with starting rate defaulted based on indication. Moreover, indications for anticoagulation interruption may be unclear. Specifically, the risk of injection site bruising and/or bleeding may be increased. Planned glycoprotein IIb/IIIa inhibitor use: IV: Initial bolus of 60 units/kg (maximum: 7,000 units) to achieve ACT of 200 to 250 seconds (regardless of point-of-care device); repeat bolus as needed to maintain goal ACT throughout procedure (ACCF/AHA/SCAI [Levine 2011]; Cutlip 2020; Steg 2010). SubQ: 5,000 units every 8 to 12 hours, with initial dose given ≥2 hours prior to surgery. The risk for bleeding may be increased. Unfractionated heparin is indicated for prophylaxis and treatment of venous thrombosis and its extension, prevention of post-operative deep venous thrombosis and pulmonary embolism and prevention of clotting in arterial and cardiac surgery. Specifically, the risk for bleeding may be increased. Specifically, the risk for bleeding-related events may be increased. Clearance: Age-related changes; within neonatal population, slower clearance with lower GA; however, when compared to adults, the overall clearance in neonatal and pediatric patients is faster than adults (ACCP [Monagle 2012 ]; McDonald 1981), Anticoagulation: IV: Immediate; SubQ: ~20 to 30 minutes. Use with caution in patients with an increased risk of bleeding, including subacute bacterial endocarditis; congenital or acquired bleeding disorders; active ulcerative or angiodysplastic GI diseases; continuous GI tube drainage; severe uncontrolled hypertension; history of hemorrhagic stroke; use shortly after brain, spinal, or ophthalmologic surgery or other invasive procedures including spinal tap or spinal anesthesia; concomitant treatment with platelet inhibitors; recent GI bleeding; impaired hemostasis; thrombocytopenia or platelet defects; patients with hereditary antithrombin deficiency receiving concurrent antithrombin replacement therapy; severe liver disease; hypertensive or diabetic retinopathy; renal failure; or in patients (especially women) >60 years of age. Solution, Injection, as sodium [preservative free]: Generic: 1000 units/mL (2 mL); 5000 units/mL (1 mL); 5000 units/0.5 mL (0.5 mL), Generic: 1000 units (500 mL); 10,000 units (250 mL); 20,000 units (500 mL); 25,000 units (250 mL, 500 mL); 1 units/mL (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL); 10 units/mL (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL); 100 units/mL (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL); 1000 units/500 mL in NaCl 0.9% (500 mL); 25,000 units/250 mL in Dextrose 5% (250 mL); 25,000 units/250 mL in NaCl 0.45% (250 mL); 25,000 units/500 mL in Dextrose 5% (500 mL). This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Avoid combination, Vitamin E (Systemic): May enhance the anticoagulant effect of Anticoagulants. 2. Parenteral nutrition (PN) additive, venous access patency: Infants, Children, and Adolescents: 1 unit/mL (final heparin concentration in PN), both central and peripheral. Monitor therapy, Nitroglycerin: May diminish the anticoagulant effect of Heparin. 4. Monitor patient closely for signs or symptoms of bleeding. Avoid combination, Omega-3 Fatty Acids: May enhance the anticoagulant effect of Anticoagulants. cUse actual body weight for calculations. Order goal anti-Xa level (low intensity 0.3-0.5 units/mL or regular intensity 0.3-0.7 units/mL). Mechanical heart valve, bridging anticoagulation (for interruptions in warfarin therapy) (off-label use): Note: Bridging during intervals of subtherapeutic anticoagulation should be considered for patients with mechanical mitral or tricuspid valve replacement; however, for patients with mechanical aortic valve replacement, bridging is not required unless an additional thromboembolic risk factor is present or patient has an older-generation mechanical aortic valve (AHA/ACC [Nishimura 2017]). Order as needed Re-Bolus for subtherapeutic anti-Xa, if warranted. Angiomax® (bivalirudin) for Injection is a direct thrombin inhibitor indicated for use as an anticoagulant in patients: ... (HIT) or heparin-induced thrombocytopenia and thrombosis syndrome (HITTS), undergoing PCI; and • With unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA). Removal of recommendations for heparin monitoring and dose titrations using PTT Key Practice Recommendations 1. Monitor therapy, Telavancin: May diminish the therapeutic effect of Heparin. Avoid combination, Dasatinib: May enhance the anticoagulant effect of Anticoagulants. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet. Consider therapy modification, Ibritumomab Tiuxetan: Anticoagulants may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Specifically, oritavancin may artificially increase the results of laboratory tests commonly used to monitor IV heparin effectiveness, which could lead to incorrect decisions to decrease heparin doses. with heparin or other anticoagulants is a common clinical dilemma. Venous thromboembolism treatment, deep vein thrombosis and/or pulmonary embolism: Note: Some experts prefer IV heparin for initial therapy in patients who are hemodynamically unstable, may need invasive procedures or thrombolysis due to extensive clot burden, are obese, have renal failure, or when rapid reversal of anticoagulation may be needed (Lip 2019). Premature neonates (data based on single dose of 100 units/kg within 4 hours of birth) (McDonald 1981): Inversely proportional to gestational age (GA). 3. Therefore, we recommend the request of antibody detection to confirm a fresh SARS-CoV-2 infection. Planned glycoprotein IIb/IIIa inhibitor use: IV: Initial bolus of 50 to 70 units/kg (maximum: 7,000 units) to achieve ACT of 200 to 250 seconds (regardless of point-of-care device); repeat bolus as needed to maintain goal ACT throughout procedure (ACCF/AHA [O’Gara 2013]; ACCF/AHA/SCAI [Levine 2011]; AHA/ACC [Amsterdam 2014]; Cutlip 2020). Atrial fibrillation (to prevent stroke and systemic embolism): Note: When admitted for short-term hospitalization (eg, admission for a procedure or surgery), ambulatory patients taking an oral anticoagulant and not at high risk of immediate thromboembolism typically do not require bridging anticoagulation. Select the dose adjustment nomogram based on indication for UFH use 1.1 Gradual heparin nomogram Injection sites should be rotated (usually left and right portions of the abdomen, above iliac crest). For patients with mechanical aortic valve replacement, bridging is not required unless an additional thromboembolic risk factor is present or the patient has an older-generation mechanical aortic valve. 5-Aminosalicylic Acid Derivatives: May enhance the adverse/toxic effect of Heparin. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. • Bleeding: May occur, including fatal events. Monitor therapy, Streptokinase: May enhance the anticoagulant effect of Heparin. Transitioning from IV heparin to another anticoagulant: Transitioning from a therapeutic dose of IV heparin to therapeutic SubQ low-molecular-weight heparin or SubQ fondaparinux: Stop IV heparin and within 1 hour start SubQ LMWH or SubQ fondaparinux. Part 1: Risk Assessment and General Recommendations, Guidelines for Prevention of VTE in Hospitalized Patients. WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Clinical experience also suggests the utility of heparin for this use [Gaasch 2019a]. Most trials comparing regional citrate with systemic heparin anticoagulation in continuous kidney replacement therapy had a low number of patients and mainly focused on filter life span. Central line flush; patency (intermittent doses): Limited data available (ACCP [Monagle 2012]; Conway 2014; Lee 2005): Infants, Children, and Adolescents: When using intermittent flushes of heparin to maintain patency of single and double lumen central catheters, various recommendations exist; refer to institution specific protocols. Adults: Following a single 75 unit/kg dose: 36.6 ± 7.4 mL/kg (McDonald 1981). Available for Android and iOS devices. Heparin resistance. Refer to separate drug interaction content and to full drug monograph content regarding use of rivaroxaban with vitamin K antagonists (eg, warfarin, acenocoumarol) during anticoagulant transition and bridging periods. If used concomitantly, increase diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds). Adjusted dose (therapeutic): Note: Reserved for patients at the highest VTE risk (eg, history of recurrent thrombosis, severe thrombophilia). Key Revisions 1. Monitor therapy, Icosapent Ethyl: May enhance the anticoagulant effect of Anticoagulants. Use is considered contraindicated under some circumstances. Order goal anti-Xa level (low intensity 0.3-0.5 units/mL or regular intensity 0.3-0.7 units/mL). Last updated on Sep 10, 2020. Thrombocytopenia has been reported to occur at an incidence between 0% and 30%. Transitioning from warfarin to a therapeutic dose of IV heparin: Stop warfarin and, when INR is as close as possible to the lower end of the targeted INR range, start IV heparin without a bolus dose (infusion rate depends on the indication) (Dager 2018). In order to prevent a prolonged value from being mistaken for therapeutic anticoagulation, aPTT should be measured at baseline. 1. Medical patients with acute illness at moderate to high risk for venous thromboembolism: SubQ: 5,000 units every 8 to 12 hours; continue for length of hospitalization or until fully ambulatory (ACCP [Kahn 2012]; ASCO [Key 2020]; Pai 2019a); extended prophylaxis beyond acute hospital stay is not routinely recommended (ACCP [Kahn 2012]; Sharma 2012). Avoid combination, Salicylates: May enhance the anticoagulant effect of Anticoagulants. Based on the 2009 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection, antibiotic lock therapy may be used as salvage therapy for catheter-related infections in addition to systemic antibiotics when the catheter cannot be removed. Avoid combination, Zanubrutinib: May enhance the adverse/toxic effect of Anticoagulants. Hypersensitivity to heparin or any component of the formulation (unless a life-threatening situation necessitates use and use of an alternative anticoagulant is not possible); severe thrombocytopenia; history of heparin-induced thrombocytopenia; history of heparin-induced thrombocytopenia with thrombosis; uncontrolled active bleeding; not for use when appropriate blood coagulation tests cannot be obtained at appropriate intervals (applies to full-dose heparin only). Order as needed Re-Bolus for subtherapeutic anti-Xa, if warranted. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. Overlap with warfarin until INR is stable and within therapeutic range for ≥2 consecutive days (Gaasch 2019a). Refer to separate drug interaction content and to full drug monograph content regarding use of edoxaban with vitamin K antagonists (eg, warfarin, acenocoumarol) during anticoagulant transition and bridging periods. 3,18,20,21 Only 3 trials reported mortality as an outcome measure. Medically reviewed by Drugs.com. If clotting occurs during hemodialysis: IV: Bolus 1,000 units at the beginning of the subsequent hemodialysis session, followed by a continuous infusion of 500 units/hour; stop the infusion 60 minutes before the end of hemodialysis; if clotting continues, increase continuous infusion by 100 units/hour at each subsequent session (eg, administer 600 units/hour) until clotting no longer occurs or up to a maximum of 1,000 units/hour (Kovalik 2020; Shen 2012). Avoid combination, Eplerenone: Heparin may enhance the hyperkalemic effect of Eplerenone. ... Menstruation is not a contra-indication. The evidence to inform decision making is limited, making current guidelines equivocal and imprecise. Note: Heparin is extensively bound to plasma proteins and has a low Vd, which is similar to blood volume. weight heparin (LMWH) should not be offered in the treatment of patients with COVID-19, unless there is a standard indication for therapeutic anti-coagulation, such as the acute management of acute deep vein thromboses or pulmonary emboli, or as part of a clinical trial. Management: Avoid concurrent use of anticoagulants with omacetaxine in patients with a platelet count of less than 50,000/uL. Management: Monitor serum potassium concentrations closely. Refer to related guidelines for specific recommendations. • Thrombocytopenia: Heparin-induced thrombocytopenia (HIT), a serious antibody-mediated reaction resulting from irreversible aggregation of platelets, may occur. Monitor therapy, Sulodexide: May enhance the anticoagulant effect of Anticoagulants. Urine (small amounts as unchanged drug); Note: At therapeutic doses, elimination occurs rapidly via nonrenal mechanisms. Monitor therapy, Antithrombin: May enhance the anticoagulant effect of Heparin. Venous thromboembolism prophylaxis (alternative agent): Note: Low-weight patients (eg, <50 kg) may be more sensitive to routine prophylactic doses, increasing the potential for higher than intended levels of anticoagulation; consider adhering to every-12-hour dosing interval (Dager 2018). Intended for … • Heparin resistance: Dose requirements >35,000 units/24 hours to maintain a therapeutic aPTT may occur in patients with antithrombin deficiency, increased heparin clearance, elevations in heparin-binding proteins, and elevations in factor VIII and/or fibrinogen; frequently encountered in patients with fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies, myocardial infarction, cancer, and in postsurgical patients; measurement of anticoagulant effects using anti-Factor Xa levels may be of benefit. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required. May consider 7,500 units every 8 hours in more obese patients (BMI >50 kg/m2) (expert opinion). Transitioning between anticoagulants: Note: This provides general guidance on transitioning between anticoagulants; also refer to local protocol for additional detail. The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Avoid combination, Palifermin: Heparin may increase the serum concentration of Palifermin. We comply with the HONcode standard for trustworthy health information -, 2009 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection, 2017 American Heart Association/American College of Cardiology (AHA/ACC) focused update of the 2014 guideline for the management of patients with valvular heart disease, 2012 American College of Chest Physicians guideline on antithrombotic and thrombolytic therapy for valvular disease.
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