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Heparin

Generic Name: heparin (injection) (HEP a rin)
Brand Names: Hep-Pak (obsolete), Heparin Lock Flush (obsolete), Hep-Pak CVC (obsolete), Hep-Lock (obsolete), Heparin Sodium ADD-Vantage

What is heparin injection?

Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots.

Heparin is used to treat and prevent blood clots in the veins, arteries, or lung. Heparin is also used before surgery to reduce the risk of blood clots.

Heparin injection should not be used to flush (clean out) an intravenous (IV) catheter. A separate heparin product is available to use as catheter lock flush.

Important information

Heparin injection should not be used to flush (clean out) an intravenous (IV) catheter. A separate heparin product is available to use as catheter lock flush.

You should not use heparin if you have uncontrolled bleeding or a severe lack of platelets in your blood.

Heparin increases your risk of bleeding, which can be severe or life-threatening. You will need frequent tests to measure your blood-clotting time.

Call your doctor or seek emergency medical attention if you have unusual bleeding or bruising, severe stomach or back pain, unusual tiredness, a nosebleed, blood in your urine or stools, coughing up blood, or any bleeding that will not stop.

Heparin can cause you to have bleeding episodes while you are using it and for several weeks after you stop.

Certain medicines can increase your risk of bleeding while you are using heparin, such as aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), nabumetone (Relafen), piroxicam (Feldene), and others. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Before taking this medicine

You should not use this medicine if you are allergic to heparin or pork products, or if you have:

  • a severe lack of platelets in your blood; or

  • uncontrolled bleeding.

To make sure heparin is safe for you, tell your doctor if you have ever had:

  • an infection of the lining of your heart (also called bacterial endocarditis);

  • uncontrolled high blood pressure;

  • a bleeding or blood clotting disorder;

  • a stomach or intestinal disorder;

  • liver disease;

  • if you use a blood thinner (warfarin, Coumadin, Jantoven) and you have routine "INR" or prothrombin time tests; or

  • if you are having a menstrual period.

It is not known whether heparin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Do not use heparin without telling your doctor if you are breast-feeding a baby.

Women over 60 years of age may be more likely to have bleeding episodes while using heparin.

How should I use heparin injection?

Heparin is injected under the skin or into a vein through an IV. You may be shown how to use injections at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of needles, IV tubing, and other items used.

Do not use the medicine if it has changed colors or has particles in it. Call your pharmacist for new medicine.

You may be switched from injectable heparin to an oral (taken by mouth) blood thinner. Do not stop using the heparin until your doctor tells you to. You may need to use both the injection and the oral forms of heparin for a short time.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

To be sure heparin is helping your condition, you may need frequent blood tests. The timing of these tests is very important in helping your doctor determine whether it is safe for you to continue using heparin.

Store at room temperature away from moisture and heat.

Dosage Information (comprehensive)

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of heparin.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include easy bruising, nosebleeds, blood in your urine or stools, black or tarry stools, or any bleeding that will not stop.

What should I avoid while using heparin injection?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with heparin may cause you to bleed more easily.

Heparin injection side effects

Get emergency medical help if you have signs of an allergic reaction to heparin: nausea, vomiting, sweating, hives, itching, trouble breathing, swelling of your face, lips, tongue, or throat, or feeling like you might pass out.

Heparin may cause you to bleed more easily, which can be severe or life-threatening. You may also have bleeding on the inside of your body. Seek emergency medical attention if you have:

  • any unusual bleeding or bruising;

  • severe pain in your stomach, lower back, or groin;

  • swelling or bruising in your lower stomach or groin area;

  • nausea, vomiting, loss of appetite;

  • unusual tiredness;

  • any bleeding that will not stop; or

  • other signs of bleeding, such as a nosebleed, blood in your urine or stools, black or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

Heparin can cause you to have bleeding episodes while you are using it and for several weeks after you stop.

Stop using heparin and call your doctor at once if you have:

  • signs of a blood clot - sudden numbness or weakness, severe headache, slurred speech, problems with speech or vision, chest pain, sudden cough, wheezing, swelling or warmth in one or both legs;

  • fever, chills, runny nose, or watery eyes;

  • trouble breathing; or

  • (in an infant) extreme drowsiness, weakness, or gasping for breath.

Common heparin side effects may include:

  • mild pain, redness, warmth, or skin changes where the medicine was injected;

  • mild itching of your feet; or

  • bluish-colored skin.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Side effects (complete list)

Heparin dosing information

Usual Adult Dose of Heparin for Deep Vein Thrombosis:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Deep Vein Thrombosis -- Prophylaxis:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Prevention of Thromboembolism in Atrial Fibrillation:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Pulmonary Embolism:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Thrombotic/Thromboembolic Disorder:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Disseminated Intravascular Coagulation:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Venous Thromboembolism:

The manufacturer provides the following dosing guidelines based on clinical experience:

Continuous IV infusion:
-Initial dose: 5000 units by IV injection
-Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion

Intermittent IV injection:
-Initial dose: 10,000 units IV
-Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours

Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.

Comments:
-Recommended doses are based on a 68 kg patient.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
-Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
-Prophylaxis and treatment of peripheral arterial embolism.


5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.

Comments:
-Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.

Usual Adult Dose of Heparin for Cardiothoracic Surgery:

Initial dose: At least 150 units/kg; frequently, 300 units/kg is used for procedures estimated to last less than 60 minutes or 400 units/kg for those estimated to last longer than 60 minutes.

Comments:
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prevention of clotting in arterial and cardiac surgery.
-Total body perfusion for open-heart surgery.

Usual Adult Dose of Heparin for Vascular Surgery:

Initial dose: At least 150 units/kg; frequently, 300 units/kg is used for procedures estimated to last less than 60 minutes or 400 units/kg for those estimated to last longer than 60 minutes.

Comments:
-Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
-Dosage and administration must be individualized according to the results of suitable laboratory tests.

Uses:
-Prevention of clotting in arterial and cardiac surgery.
-Total body perfusion for open-heart surgery.

Usual Adult Dose of Heparin for Blood Transfusion:

Addition of 400 to 600 USP units per 100 mL of whole blood is usually employed to prevent coagulation

Use: Anticoagulant use in blood transfusions.

Usual Adult Dose of Heparin for Patency Maintenance of Indwelling Intravenous Devices:

6 units/hr (using 2 units/mL formulation) has been found to be satisfactory

Comments: Rate of infusion depends upon age, weight, clinical condition, and procedure being employed.

Use: To aid in the maintenance of catheter patency.

Usual Pediatric Dose of Heparin for Thrombotic/Thromboembolic Disorder:

There are no adequate and well controlled studies in pediatric patients. The manufacturer provides the following dosing guidelines based on clinical experience:
-Initial dose: 75 to 100 units/kg IV bolus over 10 minutes
-Maintenance dose: Infants: 25 to 30 units/kg/hr; Children greater than 1 year: 18 to 20 units/kg/hr

Comments:
-Use preservative-free formulations of this drug in neonates and infants.
-Adjust dose to maintain activated partial thromboplastin time (aPTT) of 60 to 85 seconds, assuming this reflects an anti-Factor Xa level of 0.35 to 0.7.
-Infants less than 2 months have the highest requirements (average dose of 28 units/kg/hr).
-Older children may require less of this drug, similar to weight-adjusted adult dosage.

What other drugs will affect heparin injection?

Using certain medicines with heparin can cause you to bleed more easily. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all your current medicines and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about heparin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use heparin only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient.

Copyright 1996-2017 Cerner Multum, Inc. Version: 11.01.

Date modified: July 08, 2017
Last reviewed: May 23, 2017

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