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PosiFlush (heparin flush) Disease Interactions

There are 3 disease interactions with PosiFlush (heparin flush):

Major

Anticoagulants (Includes PosiFlush) ↔ Peptic Ulcer Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Bleeding

Anticoagulants are contraindicated in patients with active major bleeding or those patients at risk for hemorrhage. Hemorrhage due to heparin derivatives may be treated with protamine sulfate 1%. However, protamine sulfate may not completely neutralize the anti- Factor Xa activity.

References

  1. "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Lovenox (enoxaparin)." Rhone-Poulenc Rorer, Collegeville, PA.
  3. "Product Information. Heparin Sodium (heparin)." Lilly, Eli and Company, Indianapolis, IN.
  4. Breddin HK "Low molecular weight heparins and bleeding." Semin Thromb Hemost 15 (1989): 401-4
  5. Hirsh J, Fuster V "Guide to anticoagulant therapy. 1. Heparin." Circulation 89 (1994): 1449-68
  6. "Product Information. Orgaran (danaparoid)." Organon, West Orange, NJ.
  7. Nieuwenhuis HK, Albada J, Banga JD, Sixma JJ "Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin." Blood 78 (1991): 2337-43
  8. Oates JA, Wood AJJ "Heparin." N Engl J Med 324 (1991): 1565-74
  9. Sugiyama T, Itoh M, Ohtawa M, Natsuga T "Study on neutralization of low molecular weight heparin (LHG) by protamine sulfate and its neutralization characteristics." Thromb Res 68 (1992): 119-29
  10. Walker AM, Jick H "Predictors of bleeding during heparin therapy." JAMA 244 (1980): 1209-12
  11. Nieuwenhuis HK, Albada J, Banga JD, Sixma JJ "Identification of risk factors for bleeding during treatment of acute venous thromboembolism with heparin or low molecular weight heparin." Blood 78 (1991): 2337-43
View all 11 references
Major

Heparin (Includes PosiFlush) ↔ Prematurity

Severe Potential Hazard, Moderate plausibility

Applies to: Prematurity/Underweight in Infancy

The use of certain heparin sodium injections and heparin lock flush solutions is considered by the manufacturers to be contraindicated in premature infants and infants of low birth weight. Some formulations of these drugs contain benzyl alcohol which, in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, has been associated with fatalities and severe respiratory and metabolic complications in low-birthweight premature infants. Symptoms include a striking onset of gasping respiration, hypotension, bradycardia, and cardiovascular collapse. The manufacturers further recommend that use of these products be avoided in all neonates whenever possible. Neonates requiring heparin lock flush solution should be given a preservative-free formulation. Nevertheless, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns.

The use of heparin for maintaining patency of umbilical artery catheters may be associated with an increased risk of germinal matrix intraventricular hemorrhage in low-birthweight neonates. Although a definitive causal relationship has not been established, caution may be appropriate when heparin lock flush solutions are used.

Due to the risk of overdose, heparin lock flush solutions containing 100 units/mL should not be used in neonates, particularly those who are premature or have low birthweight.

Major

Heparin (Includes PosiFlush) ↔ Thrombocytopenia

Severe Potential Hazard, High plausibility

Applies to: Thrombocytopenia, Heparin-Induced Thrombocytopenia

The use of heparin is contraindicated in patients with severe thrombocytopenia. Acute thrombocytopenia can occur in patients receiving heparin, with a reported incidence of up to 30%. Platelet counts should be obtained before and periodically during heparin administration, including regular and repeated use of heparin flush solutions if given for longer than 5 days. Mild thrombocytopenia with counts above 100,000/mm3 may remain stable or reverse despite continued heparin administration. However, thrombocytopenia of any degree should be closely monitored. Therapy should be discontinued if the count falls below 100,000/mm3 or if recurrent thrombosis develops, and an alternative, nonheparin anticoagulant (e.g., argatroban, bivalirudin, lepirudin) administered if necessary. Heparin-induced thrombocytopenia (HIT) is a serious antibody-mediated reaction resulting from irreversible aggregation of platelets. HIT may progress to the development of venous and arterial thromboses, a condition referred to as heparin-induced thrombocytopenia and thrombosis (HITT). Thrombotic events may also be the initial presentation for HITT, and may include deep vein thrombosis, pulmonary embolism, cerebral vein thrombosis, limb ischemia, stroke, myocardial infarction, mesenteric thrombosis, renal artery thrombosis, skin necrosis, gangrene of the extremities that may lead to amputation, and possibly death. Both HIT and HITT can occur up to several weeks after the discontinuation of heparin therapy. Patients presenting with thrombocytopenia or thrombosis after discontinuation of heparin should be evaluated for HIT and HITT. Following an episode, any future use of heparin should be avoided, and use of low-molecular weight heparin should consider the potential for cross-reactivity with the HIT antibody and approached with extreme caution, if not otherwise contraindicated.

References

  1. Kelton JG, Sheridan D, Santos A, et al "Heparin-induced thrombocytopenia: laboratory studies." Blood 72 (1988): 925-30
  2. Warkentin TE, Hirsh J, Kelton JG "Heparin-induced thrombocytopenia." N Engl J Med 333 (1995): 1007
  3. Magnani HN "Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with orgaran (Org 10172) [published erratum appears in Thromb Haemost 1993 Dec 20;70(6):1072]." Thromb Haemost 70 (1993): 554-61
  4. Force RW "Heparin-induced thrombocytopenia." Am J Health Syst Pharm 52 (1995): 2528
  5. Sandler RM, Seifer DB, Morgan K, Pockros PJ, Wypych J, Weiss LM, Schiffman S "Heparin-induced thrombocytopenia and thrombosis: detection and specificity of a platelet-aggregating IgG." Am J Clin Pathol 83 (1985): 760-4
  6. Cines DB, Kaywin P, Bina M, et al "Heparin-associated thrombocytopenia." N Engl J Med 303 (1980): 788-95
  7. Kleinschmidt S, Seyfert UT "Heparin-associated thrombocytopenia (HAT) - still a diagnostic and therapeutical problem in clinical practice." Angiology 46 (1995): 37-44
  8. Berkowitz N, Beckman J "Heparin-induced thrombocytopenia." N Engl J Med 333 (1995): 1006
  9. Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M, Kelton JG "Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin." N Engl J Med 332 (1995): 1330-5
  10. Rissieri DA, Wong WM, Gockerman JP "Thrombocytosis associated with low-molecular-weight heparin." Ann Intern Med 125 (1996): 157
  11. Eichinger S, Kyrle PA, Brenner B, Wagner B, Kapiotis S, Lechner K, Korninger HC "Thrombocytopenia associated with low-molecular-weight heparin" Lancet 337 (1991): 1425-6
  12. Rizzieri DA, Wong WM, Gockerman JP "Thrombocytosis associated with low-molecular-weight heparin." Ann Intern Med 125 (1996): 157
  13. Kikta MJ, Keller MP, Humphrey PW, Silver D, Towne JB, Tsapogas M "Can low molecular weight heparins and heparinoids be safely given to patients with heparin-induced thrombocytopenia syndrome?" Surgery 114 (1993): 705-10
  14. Yamamoto S, Koide M, Matsuo M, Suzuki S, Ohtaka M, Saika S, Matsuo T "Heparin-induced thrombocytopenia in hemodialysis patients." Am J Kidney Dis 28 (1996): 82-5
  15. Platell CF, Tan EG "Hypersensitivity reactions to heparin: delayed onset thrombocytopenia and necrotizing skin lesions." Aust N Z J Surg 56 (1986): 621-3
  16. Ramakrishna R, Manoharan A, Kwan YL, Kyle PW "Heparin-induced thrombocytopenia: cross-reactivity between standard heparin, low molecular weight heparin, dalteparin (fragmin) and heparinoid, danaparoid (orgaran)." Br J Haematol 91 (1995): 736-8
  17. Hougardy N, Machiels JP, Ravoet C "Heparin-induced thrombocytopenia." N Engl J Med 333 (1995): 1007
  18. Lecompte T, Luo SK, Stieltjes N, Lecrubier C, et al "Thrombocytopenia associated with low-molecular-weight heparin." Lancet 338 (1991): 1217
  19. Chong BH, Magnani HN "Orgaran in heparin-induced thrombocytopenia." Haemostasis 22 (1992): 85-91
  20. Bergqvist D, Burmark US, Frisell J, Hallbook T, Lindblad B, Risberg B, Torngren S, Wallin G "Prospective double-blind comparison between Fragmin and conventional low-dose heparin: thromboprophylactic effect and bleeding complications." Haemostasis 16 Suppl 2 (1986): 11-8
  21. "Product Information. Orgaran (danaparoid)." Organon, West Orange, NJ.
  22. Balestra B, Quadri P, Biasiutti FD, Furlan M, Lammle B "Low molecular weight heparin-induced thrombocytopenia and skin necrosis distant from injection sites." Eur J Haematol 53 (1994): 61-3
  23. Schiele F, Vuillemenot A, Kramarz P, Kieffer Y, Anguenot T, Bernard Y, Bassand JP "Use of recombinant hirudin as antithrombotic treatment in patients with heparin-induced thrombocytopenia." Am J Hematol 50 (1995): 20-5
  24. Bell WR, Royall RM "Heparin-associated thrombocytopenia: a comparison of three heparin preparations." N Engl J Med 303 (1980): 902-7
  25. Monreal M, Lafoz E, Salvador R, Roncales J, Navarro A "Adverse effects of three different forms of heparin therapy: thrombocytopenia, increased transaminases, and hyperkalaemia." Eur J Clin Pharmacol 37 (1989): 415-8
  26. Chong BH "Heparin-induced thrombocytopenia." Aust N Z J Med 22 (1992): 145-52
  27. Tezcan AZ, Tezcan H, Gastineau DA, Armitage JO, Haire WD "Heparin-induced thrombocytopenia after bone marrow transplantation: report of two cases." Bone Marrow Transplant 14 (1994): 487-90
  28. Gruel Y, Lang M, Darnige L, Pacouret G, Dreyfus X, Leroy J, Charbonnier B "Fatal effect of re-exposure to heparin after previous heparin- associated thrombocytopenia and thrombosis ." Lancet 336 (1990): 1077-8
  29. Warkentin TE, Hayward CP, Smith CA, et al "Determinants of donor platelet variability when testing for heparin-induced thrombocytopenia." J Lab Clin Med 120 (1992): 371-9
  30. Munver R, Schulman IC, Wolf DJ, Rosengart TK "Heparin-induced thrombocytopenia and thrombosis: presentation after cardiopulmonary bypass." Ann Thorac Surg 58 (1994): 1764-6
  31. Shumate MJ "Heparin-induced thrombocytopenia." N Engl J Med 333 (1995): 1006-7
  32. "Product Information. Heparin Sodium (heparin)." Lilly, Eli and Company, Indianapolis, IN.
  33. Monreal M, Lafoz E, Salvador R, Roncales J, Navarro A "Adverse effects of three different forms of heparin therapy: thrombocytopenia, increased transaminases, and hyperkalaemia." Eur J Clin Pharmacol 37 (1989): 415-8
  34. Luzzatto G, Cordiano I, Patrassi G, Fabris F "Heparin-induced thrombocytopenia: discrepancy between the presence of IgG cross-reacting in vitro with fraxiparine and its successful clinical use." Thromb Haemost 75 (1996): 211-2
  35. Peters FPJ, Doevendans PAFM, Erdkamp FLG, Vanderent FWC, Deheer F "Low molecular weight heparin-induced thrombocytopenia and thrombosis." Eur J Haematol 56 (1996): 329-30
  36. Bleasel JF, Rasko JE, Rickard KA, Richards G "Acute adrenal insufficiency secondary to heparin-induced thrombocytopenia-thrombosis syndrome." Med J Aust 157 (1992): 192-3
  37. Rice P, Dace S, Mcmullin MF, Clements WDB "Heparin induced thrombocytopenia causing life-threatening postoperative haemorrhage." Br J Clin Pract 50 (1996): 404-5
  38. Slocum MM, Adams JG, Teel R, Spadone DP, Silver D "Use of enoxaparin in patients with heparin-induced thrombocytopenia syndrome." J Vasc Surg 23 (1996): 839-43
  39. "Product Information. Lovenox (enoxaparin)." Rhone-Poulenc Rorer, Collegeville, PA.
View all 39 references

PosiFlush (heparin flush) drug Interactions

There are 3 drug interactions with PosiFlush (heparin flush)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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