30.04.2019

Why do pregnant women need blood thinner injections?

Heparin belongs to the group of anticoagulants and is used in medical practice to influence the blood system and hematopoiesis.

Compound

The main component of the drug is heparin. Each bottle of the drug contains 25,000 units of the substance.

How is it produced?

Given medicine Available in the form of a solution for injections. Each vial contains 5 milliliters of heparin. 5 bottles are placed in a cardboard package.

Also on pharmaceutical market Heparin ointment for bruises is presented, but Heparin tablets are not available.

Due to the presence of a negative charge, the drug interacts with proteins involved in blood clotting.

When using Heparin, the following occurs:

binding to antithrombin III;
blood clotting is suppressed;
there is a violation of the transition of prothrombin to thrombin;
the coagulation process is inhibited;
lipoprotein lipase is activated, due to which it is possible to achieve a slight decrease in the level of lipids and cholesterol in the blood;
the formation of a stable fibrin lump is prevented.

Pharmacokinetics

The effect of the drug begins immediately after its use and lasts for at least 5 hours. During subcutaneous administration the desired effect occurs within an hour and lasts almost half a day.

In blood tests, max plasma levels of sodium heparin were observed over a period of 2 to 4 hours. Basic active ingredient The drug does not have the ability to cross the placenta and enter breast milk.

The metabolic process occurs in the liver, and excretion is carried out by the kidneys along with urine.

Indications

Heparin injections are used in the presence of the following ailments:

coronary syndrome in the acute stage;
thrombosis of arteries and veins and embolisms that occur in the central veins and arteries, vessels of the brain, eyes;
permanent form of atrial fibrillation followed by embolization process;
to prevent the formation of venous blood clots and embolism of the pulmonary arteries, which may occur after surgery;
to prevent the risk of thromboembolism;
prevention of blood clotting during laboratory tests, dialysis, extracorporeal circulation, vascular and cardiac surgery;
during a blood transfusion directly from a donor.

This medicine is prescribed by doctors not only to relieve these diseases, but also to prevent them.

Contraindications

Every well-studied drug has contraindications, Heparin is no exception. The instructions for use describe the following prohibitions for its use:

allergy to the main component of the drug;
thrombocytopenia;
encephalomalacia;
visceral carcinoma;
severe pancreatic diseases;
bleeding of various origins (gastric, intracranial), except for hemorrhage that occurs with embolic infarction of the lungs or kidneys;
a history of frequent bleeding of various locations;
uncontrolled severe hypertension;
hemorrhagic stroke;
severe disturbances in the functioning of the liver and kidneys;
in case of miscarriage;
during an alcohol overdose.

in the presence of acute and chronic leukemia;
during aplastic and hypoplastic anemia;
in the presence of an acute cardiac aneurysm;
for epidural pain relief during childbirth.

Dosage

The drug Heparin is used:

jet;
under the skin;
intermittently into a vein.

Before carrying out any manipulations using this product, it is necessary to conduct the following studies:

determining the time it takes for blood to clot;
thrombin time;
platelet count.

Acute thrombosis

In the presence of acute thrombosis in adult patients, therapy begins with the administration of 2-3 milliliters of heparin solution. At the same time, the blood clotting period and thrombin time are monitored. Further treatment consists of using the drug 1-2 ml every 4-6 hours.

Thrombosis prevention

One of the ways to administer Heparin is subcutaneous

To prevent the formation of blood clots, it is advisable to administer 1 milliliter of heparin every 7 hours. In the presence of the first phase of DIC, the drug is used in the form of subcutaneous injections of no more than 0.5-1 ml of solution. After a few days, the dose of the medication is slowly reduced.

Heart surgery

If a circulatory apparatus is connected during open-heart surgery, doctors administer heparin at a dose of 1500 units for every 10 kg of weight. As the duration of the procedure increases, the dose of the administered drug also increases. All adjustments to the prescription are made exclusively by the operating surgeon.

For prophylaxis, the drug is administered 1 milliliter two hours before the planned intervention, and then another milliliter up to 3 times a day for at least one week.

Use in pediatrics

Small children are prescribed Heparin in the following doses:

for intravenous administration, 50 units of the substance per 1 kg of baby’s weight;
to maintain the achieved effect, 100 units every 4 hours;
The daily dose of Heparin administered should not exceed 300 units per kilogram of the child’s weight.

Newborns use this drug only for clear indications; the dose, route of administration and course of treatment are determined individually.

Myocardial infarction that occurred repeatedly

In the presence of coronary syndrome in acute form Initially, 1 milliliter of heparin is injected as a bolus, after which it is recommended to switch to intravenous administration of the drug. The drip rate should not exceed 1000 units of the drug per hour.

The dose and rate of administration are selected in such a way as to maintain the partial thromboplastin time at a certain level, which should be higher normal indicators 2 times.

When treating all of the above diseases when using Heparin, it is important to use an anticoagulant several days before stopping the drug.

Adverse reactions

Clinical studies have shown that the following side effects most often occur when using Heparin:

hemorrhage;
the level of liver enzymes increases;
reversible thrombocytopenia develops;
allergic reactions;
skin necrosis develops at the injection site.

Also, from each system of the body, it is possible to distinguish conditions that relate to the side effects of the drug Heparin:

blood (thrombocytopenia of the first and second types, epidural and spinal hematoma develops);
mental health (depression);
central nervous system(headache attacks);
digestion (feeling of nausea, vomiting, upset stomach);
skin (hives develop, the skin on the feet itches and burns);
bones (signs of osteoporosis, demineralization);
immunity (skin rashes, development of eye problems, rhinitis, bronchospasm, asthma, cyanosis);
endocrine system (the level of thyroxine, potassium and glucose increases, the amount of cholesterol in the blood decreases);
heart and blood vessels (hemorrhage and hematoma, irritation, ulcer, atrophy at the site of drug administration).

In the presence of thrombocytopenia, there is a possibility of developing skin necrosis and blood clots in the arteries, which can be accompanied by gangrene, myocardial infarction, stroke and even death. In particularly difficult cases of the disease, Heparin therapy is discontinued.

Overdose

During long-term therapy or administration of a large dose of the drug, there is a risk of heavy bleeding.

Treatment for the condition depends on the severity of the bleeding itself. If it is insignificant, then to stop it it is enough to simply reduce the dose of the drug or discontinue therapy.

Significant bleeding requires a more serious approach:

Complete withdrawal of Heparin.
Slow introduction of an antidote, which is a solution of protamine sulfate. Its dose is calculated as follows: 1 mg of antidote is needed to neutralize 85 units of heparin.

Peculiarities

If the patient has a history of allergy to low molecular weight heparins, this drug should be used very carefully.

The main sites for subcutaneous administration of the drug

Coagulation tests are always performed before starting treatment. The platelet count is determined several times during the entire period of treatment. This is especially important to do in the period from 6 to 14 days. If there is a sharp decrease in their number, it is necessary to discontinue the use of Heparin and continue the study to determine the cause of the development of thrombocytopenia. When type 1 or 2 is detected of this disease heparin therapy is stopped completely.

The dose is selected very carefully for patients who are likely to develop bleeding. These include patients with hypertension and menstruating women.

In order to prevent significant hypocoagulation, it is necessary to reduce the dose of Heparin and not change the interval between injections.

Use of Heparin in in rare cases leads to hemorrhage in elderly patients and people with impaired renal function.

Prescription of the drug for pregnant and lactating women

Prescription for children

The drug can be used in pediatrics, provided that the dosage is selected, which depends on the child’s weight.

Effect on reaction speed

Clinical studies have shown that Heparin does not affect the reaction rate. For this reason, it can be used when driving and operating machinery.

Drug interactions

During the use of Heparin, the following drug interactions were revealed:

Direct and non-direct anticoagulants direct action help enhance the effect of Heparin.
The properties of the main component can be reduced: antiallergic drugs, tetracycline antibiotics, vitamin C, nitroglycerin.
Bleeding may occur in combination of Heparin with aspirin, phenylbutazone, clopidogrel, ticlopidine, streptokinase, ibuprofen, dipyridamole, fibrinolytics, ketorolac, methindole, cephalosporins.
A mutual decrease in activity occurs when this drug is used with tetracyclic antidepressants.
Heparin is able to displace the following drugs from protein bonds: quinidine, anaprilin.
Hyperkalemia develops when the drug is combined with ACE inhibitors and angiotensin II antagonists.
If you drink alcohol during treatment, bleeding may develop.

Incompatibility

There are certain prohibitions on the use of Heparin during the treatment of diseases:

Heparin should not be combined with other drugs in the same syringe;
when combined, complexes are formed that do not dissolve. This happens with many drugs: penicillin, colistin, vancomycin, tetracycline antibiotics, erythromycin, gentamicin.

Best before date

The drug can be used for no more than 3 years from the date of its release.

Storage

The storage conditions for the drug Heparin are indicated on its packaging. In the room where the drug will be located, the air temperature should not exceed 25 degrees, humidity is maintained at a low level, and children's access is limited. Some pharmaceutical companies indicate that their Heparin must be stored in the refrigerator.

Vacation

Heparin bottles are sold from the pharmacy only with a doctor's prescription.

Price

There is no way to answer exactly how much Heparin costs. The cost of the drug depends on the manufacturer. The price of a Russian-made medicine ranges from 270 to 320 rubles, but European drugs can cost up to 1350 rubles per package.

Heparin injections: instructions for use

Compound

Active substance: heparin - 5000 ME;
Excipients: benzyl alcohol, sodium chloride, water for injection.

Description

clear, colorless or slightly yellowish solution.

Indications for use

Prevention and therapy: deep vein thrombosis, thromboembolism pulmonary artery(including in diseases of peripheral veins), thrombosis coronary arteries, thrombophlebitis, unstable angina, acute heart attack myocardium, atrial fibrillation (including accompanied by embolization), disseminated intravascular coagulation syndrome, prevention and therapy of microthrombosis and microcirculation disorders, renal vein thrombosis, hemolyticouremic syndrome, mitral heart disease (prevention of thrombus formation), bacterial endocarditis, glomerulonephritis, lupus nephritis. Prevention of blood clotting during operations using extracorporeal circulatory methods, during hemodialysis, hemosorption, peritoneal dialysis, cytapheresis, forced diuresis, during lavage venous catheters.

Contraindications

Hypersensitivity to heparin, diseases accompanied by increased bleeding (hemophilia, thrombocytopenia, vasculitis, etc.), bleeding, cerebral aneurysm, dissecting aortic aneurysm, hemorrhagic stroke, antiphospholipid syndrome, trauma (especially craniocerebral), uncontrolled arterial hypertension, erosive and ulcerative lesions of the gastrointestinal tract intestinal tract; liver cirrhosis accompanied by varicose veins veins of the esophagus; menstrual period, threatened miscarriage, childbirth (including recent), recently performed surgical interventions in the eyes, brain, prostate gland, liver and biliary tract, condition after puncture spinal cord, pregnancy, lactation, children under 2 years of age.

Pregnancy and lactation

Although heparin does not pass into breast milk, its administration to nursing mothers in some cases caused the rapid (within 2-4 weeks) development of osteoporosis and spinal damage.

Directions for use and doses

Heparin is prescribed as a continuous intravenous infusion or as regular intravenous injections, and also subcutaneously (in the abdomen).
For prophylactic purposes - subcutaneously, 5000 IU/day, at intervals of 8-12 hours.
The usual site for SC injections is the anterolateral abdominal wall (in exceptional cases inserted into the upper area of the shoulder or thigh), using a thin needle, which should be inserted deeply, perpendicularly, into a fold of skin, held between the thumb and index finger until the solution is injected. The injection sites should be alternated each time (to avoid the formation of a hematoma). The first injection must be performed 1-2 hours before the start of surgery; V postoperative period administer within 7-10 days, and if necessary, more long time. The initial dose of heparin administered for therapeutic purposes is usually 5000 IU and is administered intravenously, after which treatment is continued using intravenous infusions.
Maintenance doses are determined depending on the route of administration:
- for continuous intravenous infusion, 1000-2000 IU/hour (24000-48000 IU/day) is prescribed, diluting heparin in 0.9% sodium chloride solution;
- for periodic intravenous injections, 5000-10000 IU of heparin is prescribed every 4 hours.
For adults with thrombosis of mild to moderate severity, the drug is prescribed intravenously at a dose of 40,000-50,000 IU/day, divided into 3-4 times; for severe thrombosis and embolism - intravenously at a dose of 80,000 IU/day, divided into 4 times with an interval of 6 hours. For health reasons, a single dose of 25,000 IU (5 ml) is administered intravenously, then 20,000 IU every 4 hours until the daily dose reaches 80,000 - 120,000 ME. With intravenous drip infusion At least 40,000 IU of heparin must be added to the daily volume of infusion solution.
Doses of heparin for intravenous administration are selected so that the activated partial thromboplastin time (aPTT) is 1.5-2.5 times greater than the control. With subcutaneous administration of small doses (5000 IU 2-3 times a day) for the prevention of thrombus formation, regular monitoring of aPTT is not required, because it increases slightly. Continuous intravenous infusion It is the most effective way the use of heparin is better than regular (periodic) injections, because provides more stable hypocoagulation and is less likely to cause bleeding.
When performing extracorporeal circulation, a dose of 140-400 IU/kg or 1500-2000 IU per 500 ml of blood is administered. During hemodialysis, 10,000 IU is first administered intravenously, then in the middle of the procedure another 30,000-50,000 IU is administered. For older people, especially women, doses should be reduced.
For children under 2 years old this dosage form cannot be prescribed.
For children over 2 years of age, the drug is administered intravenously at a dose of 500 IU/kg/day under APTT monitoring.

Side effect

Allergic reactions: skin hyperemia, drug fever,

urticaria, rhinitis, itchy skin and a feeling of heat in the soles, bronchospasm, collapse, anaphylactic shock. Dizziness, headaches, nausea, loss of appetite, vomiting, diarrhea.

Thrombocytopenia (6% of patients). Reactions of the first type are usually

manifest themselves in soft form and disappear after cessation of therapy; thrombocytopenia has severe course and can be fatal.

Against the background of heparin-induced thrombocytopenia, skin necrosis and arterial thrombosis occur, accompanied by the development of gangrene, myocardial infarction, and stroke. If severe thrombocytopenia develops (a decrease in the platelet count by 2 times from the initial number or below 100 thousand / μl), it is necessary to urgently stop using heparin.

With long-term use - osteoporosis, spontaneous bone fractures, soft tissue calcification, hypoaldosteronism, transient alopecia, increased activity of liver transaminases.

Local reactions: irritation, pain, hyperemia, hematoma and ulceration at the injection site, bleeding (the risk can be minimized with careful assessment of contraindications, regular laboratory monitoring of blood coagulation and accurate dosage).

Bleeding from the gastrointestinal tract and urinary tract, bleeding at the injection site, in areas exposed to pressure, from surgical wounds, as well as hemorrhages in other organs (adrenal glands, corpus luteum, retroperitoneal space).

Overdose

Symptoms: signs of bleeding.
Treatment: for minor bleeding caused by an overdose of heparin, it is enough to stop using it. In case of extensive bleeding, excess heparin is neutralized with protamine sulfate (1 mg of protamine sulfate per 100 IU of heparin). It must be borne in mind that heparin is rapidly eliminated, and if protamine sulfate is prescribed 30 minutes after the previous dose of heparin, only half the required dose should be administered; maximum dose protamine sulfate is 50 mg. Hemodialysis is ineffective.

Interaction with other drugs

The effect of heparin is enhanced by some antibiotics (they reduce the formation of vitamin K by intestinal microflora), acetylsalicylic acid, dipyridamole, non-steroidal anti-inflammatory drugs and other drugs that reduce platelet aggregation (which remains the main mechanism of hemostasis in patients treated with heparin), indirect anticoagulants, drugs that block tubular secretion. Weaken - actihistamine drugs, phenothiazines, cardiac glycosides, nicotinic acid, ethacrynic acid, tetracyclines, ergot alkaloids, nicotine, nitroglycerin (intravenous administration), thyroxine, adrenocorticotropic hormone, alkaline amino acids and polypeptides, protamine.
Do not mix with other medications in the same syringe.

Features of application

Heparin cannot be administered intramuscularly, because possible formation of hematomas at the injection site.
The heparin solution may turn yellow, but this does not change its activity or tolerability.
When prescribing heparin for therapeutic purposes, its dose is selected depending on the aPTT value.
While using heparin, other drugs should not be administered intramuscularly and organ biopsies should not be performed.
To dilute heparin, use only 0.9% sodium chloride solution. Features of the effect of the drug on the ability to drive vehicle or potentially dangerous mechanisms:
Not described.
The ability of a drug to influence behavior or functional indicators body, interaction with tobacco, alcohol, food:
Not identified.

Precautionary measures

Carefully
Persons suffering from polyvalent allergies (including bronchial asthma); arterial hypertension, dental procedures, diabetes mellitus, endocarditis, pericarditis, ICH, active tuberculosis, radiation therapy, liver failure, chronic renal failure, old age (over 60 years old, especially women).

Release form

Solution for injection, 5 ml in neutral glass bottles.
5 bottles with instructions for use are placed in a cardboard pack.

Storage conditions

List B. Store in a dry place, protected from light at a temperature of 8 to 15 ° C.
Keep out of the reach of children.

Best before date

4 years.
Do not use after expiration date.

Conditions for dispensing from pharmacies

On prescription.

Heparin injections analogues, synonyms and group drugs

Self-medication can be harmful to your health.
You should consult your doctor and read the instructions before use.

Heparin injections are prescribed to patients by medical professionals mainly for the purpose of thinning and preventing the formation of blood clots. In addition, Heparin injections are used for a number of diseases. Let us consider in more detail the principle of action of this drug, indications and features of its use.

What is Heparin used for? This drug belongs to pharmacological group direct acting anticoagulants. The presented drug prevents blood clotting and the formation of blood clots by slowing down the processes of fibrin formation and reducing thrombin activity.

Heparin is characterized by the presence of the following clinical properties:

Indications for use this drug is quite widespread in modern medicine. Heparin injections are prescribed to the patient for the following diseases:

Thrombophlebitis.
Acute myocardial infarction.
Glomerulonephritis.
Deep venous thrombosis.
Atrial fibrillation.
Disseminated intravascular coagulation syndrome.
Bacterial endocarditis.
Thrombosis of the coronary arteries.
Lupus nephritis.
Thromboembolism of the pulmonary arteries.
Unstable angina.
Pathological lesions of peripheral veins.
Embolization accompanying atrial fibrillation.
Arrhythmia.
Disorders of blood flow in the kidney area.
Disorders of blood microcirculation processes.
Bronchial asthma.
Rheumatism.
Some types of heart defects.
Hemolyticouremic syndrome.

Heparin reduces the risk sudden death in patients suffering from myocardial infarction or coronary artery thrombosis.

Heparin injections give a good effect as prophylactic, preventing the development of venous thrombophlebia after surgical interventions.

The drug is used in the case of so-called extracorporeal methods. In addition, this drug is widely used for blood transfusions, its selection for diagnostic studies, as well as for the purpose of washing venous catheters during hemosorption and hemodialysis procedures.

Contraindications

Despite the fairly wide range of uses of the drug, in some cases the use of Heparin injections is highly discouraged and poses a serious danger to the patient’s health. The main contraindications to its use are:

Pulmonary infarction.
Individual intolerance to certain components of the drug.
Bleeding.
Thrombocytopenia (reduced blood clotting).
Hemorrhagic diathesis.
Hemophilia.
Increased permeability of blood vessels.
Werlhof's disease.
Aplastic anemia.
Leukemia in acute or chronic form.
Venous gangrene.
Hypoplastic anemia.
Kidney failure.
Liver pathologies.
Acute cardiac aneurysm.
Ulcerative lesions of the stomach and duodenum.
Arterial hypertension in severe form.
Transferred surgical interventions in the area of the brain, visual apparatus, prostate gland.
Hemorrhagic stroke.
Recent spinal cord puncture.
Polyvalent allergy.
Ulcerative colitis.
Availability tumor neoplasms oncological nature in the gastrointestinal tract.
Varicose veins of the esophagus.
Traumatic brain injury.

This medicine is used with extreme caution during pregnancy and breastfeeding. Usually the drug is prescribed only in exceptional cases, when its benefit to the mother significantly exceeds possible harm for a child.

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Side effects

In some cases, the use of Heparin injections can lead to the development of the following undesirable reactions:

allergy;
hives;
thrombocytopenia;
rhinitis;
bronchial spasms;
bleeding;
formation of hematomas (especially in the case of intramuscular administration of Heparin);
osteoporosis;
nausea;
bouts of vomiting;
headaches reminiscent of migraine in nature;
disruption of digestive processes;
diarrhea;
fever;
necrosis of the skin;
disruption of calcium distribution processes in the soft tissue area;
hyperemia.

It is worth noting that in most cases the development of the above side effects observed with prolonged and uncontrolled use of Heparin. In order to minimize risks, the therapeutic course must be carried out exclusively as prescribed by a doctor and under his strict supervision.

Types of injections

The instructions for use of Heparin state that the dosage and duration of treatment depend on the disease, its severity and are prescribed individually in each specific case. The drug is administered intravenously, subcutaneously or intramuscularly. Most quick effect observed when intramuscular injections(in approximately 30 minutes). In the case of subcutaneous administration, the effect occurs after 1 hour.

As a preventative measure, in most cases the patient is prescribed subcutaneous injections of Heparin in the abdomen, at time intervals of 8 to 12 hours. The dosage and frequency of Heparin injections in the stomach, used to combat certain diseases, are prescribed by the attending physician, taking into account factors such as the patient’s age, his diagnosis, general state health, the presence of concomitant ailments.

It is strictly contraindicated to give injections in the same place, as well as to take any medications without permission, since Heparin actively reacts with wide range drugs.

In the case of a long therapeutic course, it is necessary to monitor clinical picture blood, conducting regular blood tests.

Heparin injections are a very effective drug that helps prevent and accelerate the treatment of a number of diseases.

However, this drug, if taken uncontrolled, can provoke the development of numerous side effects and life-threatening bleeding. Therefore, therapy should be carried out under the strict supervision of the attending physician.

The substance has a direct anticoagulant effect, promotes the lysis of blood clots, and also has a hypocholesterolemic effect. Its weak immunosuppressive effect allows it to be prescribed as part of combination therapy autoimmune diseases.

Why are heparin injections given in the stomach?

Heparin injections are made into the anterior surface of the abdomen insulin syringe with a thin needle. This is very convenient because the patient usually gives the injections on his own. Moreover, the intensity pain weak in this area. Since injections have to be given frequently, the large surface of the anterior abdominal wall allows you not to inject the drug into the same place and avoid the appearance subcutaneous hematomas and painful infiltrates.

Heparin is administered intravenously at a dosage of 5 thousand IU (contents of one ampoule). Then you can inject the medicine intramuscularly or subcutaneously. The dosage regimen and frequency of administration are determined by the doctor on an individual basis.

Instructions for administering heparin injections into the abdomen

The developed algorithm will help to minimize discomfort and possible local complications:

Clean hands are the main rule that a patient should know. If an injection is given to another person, it makes sense to use medical gloves.
Take out the ampoule, wipe it with alcohol or a disinfectant wipe, and open it. Prepare a syringe with a needle and have a supply of alcohol wipes.
Draw the medicine into the syringe.
Handle alcohol solution the area of future injection, retreating two centimeters to the side from the navel. Pull back the skin fold (the thicker it is, the less painful the injection will seem) and stick a needle into it, inject the medicine.
Pull out the needle, simultaneously applying a napkin with alcohol to the puncture area, hold until the bleeding stops.
Injections are given in different areas of the umbilical region. Before making the injection, palpate the skin and check that there are no unresolved infiltrates or “bumps”.

Indications for use

Heparin injections into the stomach are given for:

acute inflammatory damage to the myocardium;
life-threatening arrhythmias;
some heart abnormalities;
myocardial infarction;
Consumption coagulopathies;
Gasser's disease;
autoimmune kidney diseases;
infectious inflammation of the inner lining of the heart;
to prevent coagulopathy during hemodialysis and blood transfusion;
to prevent thrombosis of any location, regardless of the cause;
for postoperative therapy of patients prone to blood clotting defects.

Contraindications

A ban on the use of the drug in the form of injections with an insulin syringe into the stomach is imposed in the following conditions:

At pathological conditions, which are characterized by a reduced rate of blood clotting.
Ulcerative lesions of the digestive tract (gastric, duodenal or ileum, nonspecific ulcerative colitis, malignant tumors).
Subacute infectious inflammation inner lining of the heart.
Failure of liver or kidney function.
Blood diseases.
Aneurysms, aortic dissection.
Bulging of the heart wall.
Haemorrhoids.
Diabetic retinopathy.
Varicose veins
In the prenatal period in postpartum women and during menstruation.

Bleeding from mucous membranes, wounds, internal organs.
Urticaria, skin itching, angioedema.
Decreased peripheral blood platelet count.
Drowsiness, loss of appetite, decreased performance.
Subcutaneous hemorrhages (bruises) at the injection site.

A number of patients develop a perverted reaction to Heparin - resistance. As a rule, these are those who have accompanying illnesses somatic nature, as well as due to a number of physiological conditions having reduced immunity (for example, during pregnancy and breastfeeding). This diagnosis is difficult to make due to vague symptoms and can lead to life-threatening bleeding.

Prescription of Heparin injections for pregnant women

In general, the drug is not prohibited for use in this group of patients. The injections are intramuscular, the dosages are small, and the courses of treatment are short. The drug is not contraindicated during breastfeeding, as it does not pass into breast milk.

The risk group includes children under 3 years of age and elderly patients.

Overdose

Exceeding the dose of the drug can be fatal due to the development heavy bleeding that are difficult to stop. The antidote for Heparin is protamine sulfate. It requires very slow administration, and to avoid complications this procedure must be performed in a hospital setting.

The drug must be dosed carefully and the state of blood clotting must be monitored. Therefore, self-medication in in this case contraindicated. Even if the patient is well acquainted with the characteristics of his disease and has been treated with Heparin and its substitutes for a long time, he should still be under the supervision of his doctor.

What are Heparin injections used for and how to administer them correctly

The instructions classify heparin injections as anticoagulant drugs. They are used to thin the blood and prevent the formation of blood clots. In addition, Heparin slows down the process of blood clotting, inhibits the formation of fibrin and reduces thrombin activity. Like any other medicine, Heparin injections have indications and contraindications for use, side effects and features of use. Possession of such information will help make treatment as effective as possible.

general information

As an injection Heparin is available in single dose vials. Each bottle contains ED active substance. Its molecules have a negative charge, due to which they can interact with proteins that are actively involved in the process of blood clotting. And Heparin is also available in the form of an ointment (gel). This drug is not available in other forms.

How does Heparin affect humans:

Blood clots less intensively.
Slows down the process of platelet adhesion.
Dilates blood vessels.
Inhibits the process of formation of immunoglobulins.
Reduces cholesterol and blood lipids.
Prevents the formation of fibrin lump.

Heparin injections, according to the instructions, begin to act immediately after administration. The effect lasts approximately 5 hours. If administered subcutaneously, improvement is observed within an hour, and the effect will last up to 12 hours.

The maximum level of the active substance is observed after approximately 2-4 hours. The liver is responsible for its processing, and the kidneys for excretion.

It is worth noting that this remedy does not have the ability to penetrate the placenta to the child. Likewise, it does not pass into breast milk.

When and when not to use the drug in treatment

Heparin injections into the stomach are indicated in several cases:

Acute stage of coronary syndrome.
Thrombosis and embolism affecting the veins and arteries of the brain and eyes.
A condition of atrial fibrillation leading to subsequent embolism.
As preventive measure the appearance of blood clots and embolism in the lungs. Such disorders often develop after surgery.
To reduce the risk of thromboembolism.
To prevent blood clotting during laboratory blood tests, dialysis procedures, or surgical operations on the heart and blood vessels.
In the process of blood transfusion directly from the donor to the patient.
Glomerulonephritis.
Nephritis.
Unstable angina.
Arrhythmia.
Poor circulation in the kidney area.
Rheumatism.
Asthma.
Heart disease.

Injections of this drug help relieve the symptoms of serious diseases and, in some situations, completely cure them.

But it also happens that doing them is strictly prohibited:

Individual intolerance to the main active ingredient.
Thrombocytopenia.
Encephalomalacia. This is a pathology in which wet necrosis of brain tissue begins.
Visceral carcinoma (malignant neoplasm).
Severe diseases of the pancreas.
Internal bleeding. An exception is hemorrhage that occurs due to high permeability of the vascular walls.
Hypertension.
Stroke.
Problems with the kidneys and liver.
Problems with pregnancy.
Excessive consumption of alcoholic beverages.

And also Heparin should not be injected:

intramuscularly;
with leukemia;
for anemia;
if there is an acute aortic aneurysm;
as a means of pain relief during childbirth.

Dosage and rules of use of the drug

Heparin is administered in several ways:

subcutaneously;
jet;
into the vein intermittently.

Before the injection is given, you need to find out:

blood clotting time;
thrombin time;
platelet level.

The dosage of the medicine depends on the specific situation:

In acute thrombosis, it is necessary to administer 1-2 ml of the drug 4-6 times a day. In this case, the first dose should be slightly larger than all the others - 2-3 ml.
To prevent thrombosis, it is necessary to give injections every 7 hours (1 ml). If the first phase of DIC appears, the drug is administered subcutaneously in an amount of 0.5-1 ml. Over time, the dose is reduced.
During heart surgery, Heparin is administered by injection according to a special scheme. Initially, the dose is 1500 units per 10 kg of patient weight. The longer the operation lasts, the higher the dose should be. And it is also necessary to administer 1 ml of the drug approximately 60 minutes before the operation and the same amount three times a day after it.
The instructions for use indicate that Heparin can be used to treat young children. To make an intravenous injection, you need to take 50 units of medication per 1 kg of the child’s weight. To maintain the effect, inject 100 units every 4 hours. It is worth remembering that the maximum permissible dose of Heparin for young children is 300 units per 1 kg of their weight.
When repeated myocardial infarction occurs, 1 ml of medication is injected in a stream. Afterwards they put in an IV. Its rate should not exceed 1000 units of Heparin per hour.

Rules for drug administration and side effects

Most often you have to inject Heparin into the stomach. It's easy to do.

The main thing is to follow the instructions for Heparin injections:

First of all, you should wash your hands thoroughly with soap. Dry them with a towel. If the injection needs to be given to another person, it is recommended to wear sterile rubber gloves.
Prepare everything you might need in advance. This is an ampoule with Heparin, a syringe of the required volume, alcohol or calendula/hawthorn tincture to disinfect the injection site and a piece of sterile cotton wool.
Open the ampoule with the medicine. Carefully draw it into the syringe.
Moisten a cotton swab with alcohol and wipe the skin with it. Measure a distance equal to two fingers on one side of the navel. Grasp the skin with your fingers. It is desirable that the fold be thicker. Then it is easier to insert the needle.
Insert the needle into the skin while injecting Heparin. The rate of administration of the medicine can be adjusted depending on your feelings.
Pull out the needle.
Wipe the injection site with a cotton swab moistened with alcohol.

For one it is worth administering as much medicine as the doctor prescribed. The same applies to the duration of treatment.

If you use Heparin uncontrolled, side effects may develop:

Most often there is an allergy.
The level of liver enzymes increases.
Thrombocytopenia develops.
Necrosis of the skin at the site where the injection was given.
Hives.
Allergic runny nose.
Spasms in the bronchi.
Bleeding of various natures.
Hematomas. Most often they appear when the drug is administered intramuscularly.
Osteoporosis.
From the gastrointestinal tract - nausea and vomiting.
Headache and even migraine.
Digestive problems.
Stomach upset.
Feverish condition.
Hyperemia or redness of the skin.

Overdose and interaction with other drugs

An overdose condition is a consequence of the administration of too large doses of Heparin or a prolonged course of treatment. Its main symptom is bleeding. In most cases, it is necessary to reduce the dosage or stop treatment with Heparin.

In more complex situations, you should act differently:

Completely exclude the drug from prescriptions.
Start administering the antidote. In this case, its role is played by a solution of protamine sulfate. To neutralize 85 units of Heparin, you need to administer 1 mg of an antidote substance.

The correct dosage is not the only thing you should pay close attention to.

It is also important to study the rules for combining Heparin with other medications:

All anticoagulants increase the effect of taking the drug.
Allergy medications, vitamin C, Nitroglycerin and some antibiotics reduce the effectiveness of Heparin.
If you inject Heparin at the same time as taking Aspirin, Ticlopidine, Ibuprofen, Ketorolac and other similar drugs, the risk of bleeding increases.
The simultaneous use of tetracyclic antidepressants and Heparin greatly reduces the effectiveness of both.
When using Heparin with ACE inhibitors and angiotensin 2 antagonists, hyperkalemia may develop.

Injections with Heparin perfectly thin the blood and prevent the formation of blood clots. The drug is usually administered subcutaneously (injections in the abdomen). It must be used with extreme caution in treatment. Why? It has contraindications for use and side effects. In addition, when it is used together with other medications, the effectiveness of both itself and the drugs with which it is combined may decrease.

Heparin injections: instructions for use

Compound

Excipients: benzyl alcohol, sodium chloride, water for injection.

Description

Indications for use

Contraindications

Pregnancy and lactation

Directions for use and doses

For prophylactic purposes - subcutaneously, 5000 IU/day, at intervals of 8-12 hours.

The usual site for subcutaneous injections is the anterolateral wall of the abdomen (in exceptional cases, it is inserted into the upper area of the shoulder or thigh), using a thin needle, which should be inserted deeply, perpendicularly, into a fold of skin, held between the thumb and index finger until the injection is completed. solution. The injection sites should be alternated each time (to avoid the formation of a hematoma). The first injection must be performed 1-2 hours before the start of surgery; in the postoperative period, administer for 7-10 days, and if necessary, for a longer time. The initial dose of heparin administered for therapeutic purposes is usually 5000 IU and is administered intravenously, after which treatment is continued using intravenous infusions.

Maintenance doses are determined depending on the route of administration:

For continuous intravenous infusion, prescribe IU/hour IU/day), diluting heparin in a 0.9% sodium chloride solution;

For periodic intravenous injections, 0 IU of heparin is prescribed every 4 hours.

For adults with thrombosis of mild to moderate severity, the drug is prescribed intravenously at a dose of 00 IU/day, divided by 3-4 times; for severe thrombosis and embolism - intravenously in a dose of IU/day, divided into 4 times with an interval of 6 hours. For health reasons, a single IU (5 ml) is administered intravenously, then IU every 4 hours until a daily dose of 20,000 IU is reached. For intravenous drip infusion, at least IU of heparin must be added to the daily volume of infusion solution.

Doses of heparin for intravenous administration are selected so that the activated partial thromboplastin time (aPTT) is 1.5-2.5 times greater than the control. With subcutaneous administration of small doses (5000 IU 2-3 times a day) for the prevention of thrombus formation, regular monitoring of aPTT is not required, because it increases slightly. Continuous intravenous infusion is the most effective way to use heparin, better than regular (periodic) injections, because provides more stable hypocoagulation and is less likely to cause bleeding.

When performing extracorporeal blood circulation, it is administered in a dose of IU/kg or IU per 500 ml of blood. During hemodialysis, ME is first administered intravenously, then another 00 ME is administered in the middle of the procedure. For older people, especially women, doses should be reduced.

This dosage form should not be prescribed to children under 2 years of age.

For children over 2 years of age, the drug is administered intravenously at a dose of 500 IU/kg/day under APTT monitoring.

Side effect

Allergic reactions: skin hyperemia, drug fever,

urticaria, rhinitis, itching and feeling of heat in the soles, bronchospasm, collapse, anaphylactic shock. Dizziness, headaches, nausea, loss of appetite, vomiting, diarrhea.

Thrombocytopenia (6% of patients). Reactions of the first type are usually

appear in a mild form and disappear after cessation of therapy; thrombocytopenia is severe and can be fatal.

With long-term use - osteoporosis, spontaneous bone fractures, soft tissue calcification, hypoaldosteronism, transient alopecia, increased activity of “liver” transaminases.

Typical are bleeding from the gastrointestinal tract and urinary tract, bleeding at the injection site, in areas exposed to pressure, from surgical wounds, as well as hemorrhages in other organs (adrenal glands, corpus luteum, retroperitoneal space).

Overdose

Treatment: for minor bleeding caused by an overdose of heparin, it is enough to stop using it. In case of extensive bleeding, excess heparin is neutralized with protamine sulfate (1 mg of protamine sulfate per 100 IU of heparin). It must be borne in mind that heparin is rapidly eliminated, and if protamine sulfate is prescribed 30 minutes after the previous dose of heparin, only half the required dose should be administered; The maximum dose of protamine sulfate is 50 mg. Hemodialysis is ineffective.

Interaction with other drugs

Do not mix with other medications in the same syringe.

Features of application

The heparin solution may turn yellow, but this does not change its activity or tolerability.

When prescribing heparin for therapeutic purposes, its dose is selected depending on the aPTT value.

While using heparin, other drugs should not be administered intramuscularly and organ biopsies should not be performed.

To dilute heparin, use only 0.9% sodium chloride solution. Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms:

The ability of a drug to influence the behavior or functional parameters of the body, interaction with tobacco, alcohol, food:

Precautionary measures

Persons suffering from polyvalent allergies (including bronchial asthma); arterial hypertension, dental procedures, diabetes mellitus, endocarditis, pericarditis, ICH, active tuberculosis, radiation therapy, liver failure, chronic renal failure, old age (over 60 years, especially women).

Release form

5 bottles with instructions for use are placed in a cardboard pack.

Storage conditions

Keep out of the reach of children.

Best before date

Do not use after expiration date.

Conditions for dispensing from pharmacies

You should consult your doctor and read the instructions before use.

Heparin - injections

Heparin is a drug that is a direct anticoagulant, that is, it inhibits blood clotting. This medicine is produced in the form of forms for external use and liquid for injection. But most often a Heparin solution is used, since it begins to slow down the formation of fibrin more quickly.

Indications for use of Heparin

After the administration of Heparin, blood flow in the kidneys is activated, changes cerebral circulation and the action of some enzymes decreases. That is why these injections are very often used for the treatment and prevention of myocardial infarctions. This drug is prescribed for increased quantities and with pulmonary embolism.

Indications for the use of Heparin are also:

deep vein thrombosis;
angina pectoris;
coronary artery thrombosis;
arrhythmia;
thrombophlebitis;
poor blood flow in the kidneys;
some types of heart defects;
lupus nephritis;
glomerulonephritis;
bacterial endocarditis.

In reduced doses, this medicine is used to prevent venous thromboembolism and in the first phase of DIC syndrome.

Heparin injections are also used during surgical interventions to prevent the patient’s blood from clotting too quickly.

How to use Heparin

The fastest effect comes after intravenous administration Heparin injections. For those who have had it done intramuscular injection, the medicine will begin to act only after fifteen to thirty minutes, and if the injection is made under the skin, the effect of Heparin will begin in about an hour.

When this drug is prescribed as a preventative measure, it is most often given by subcutaneous injection into the abdomen of five thousand units. Between such injections there should be intervals of 8 to 12 hours. It is strictly forbidden to inject Heparin subcutaneously into the same place.

For treatment, different doses of this medicine are used, which are selected by the doctor depending on the nature and type of the disease and individual characteristics the patient's body. You cannot prescribe Heparin injections into the stomach yourself, nor use the drug with other medications without warning your doctor, since this anticoagulant interacts with many medications. But at the same time use Heparin and vitamins or biologically active additives possible without fear.

To dilute the drug use saline, since it cannot be mixed with other medications in the same syringe. Features of the administration of Heparin are that after intramuscular administration the formation of hematomas is possible, and with long-term treatment This medicine may cause side effects:

allergic reactions;
Digestion or coordination problems;
disturbance of calcium distribution;
migraine-like pain.

Contraindications to the use of Heparin

Heparin should be used with caution during pregnancy and while breastfeeding. Only after consulting a doctor can you use this medicinal product for those who suffer from polyvalent allergies.

Heparin injections are not given in the abdomen, intravenously or intramuscularly if the patient has:

stomach ulcer;
nonspecific ulcerative colitis;
liver dysfunction;
malignant neoplasms in the gastrointestinal tract;
subacute bacterial endocarditis;
renal dysfunction;
arterial hypertension;
hemorrhagic stroke;
hypersensitivity to the drug.

Also, you should not use the drug for those who have recently undergone surgery on the eyes, brain, liver or prostate gland.

How and why is Heparin injection used?

Pharmacological action and clinical properties

What is Heparin used for? This drug belongs to the pharmacological group of direct-acting anticoagulants. The presented drug prevents blood clotting and the formation of blood clots by slowing down the processes of fibrin formation and reducing thrombin activity. Heparin is characterized by the presence of the following clinical properties:

increase in the negative charge of blood elements;
reduction of blood clotting factors;
decreased adhesion;
decreased aggregation of blood cells (leukocytes, erythrocytes, platelets);
antiallergic effect;
vasodilating effect;
blocking the processes of lymphocyte cooperation;
obstacle to the formation of immunoglobulins;
fibrinolytic property;
anticoagulant effect;
obstacle to stasis development;
binding of histamine to serotonin.

Indications for use

Due to its clinical properties and characteristics, this drug is quite widespread in modern medicine. Heparin injections are prescribed to the patient for the following diseases:

Thrombophlebitis.
Acute myocardial infarction.
Glomerulonephritis.
Deep venous thrombosis.
Atrial fibrillation.
Disseminated intravascular coagulation syndrome.
Bacterial endocarditis.
Thrombosis of the coronary arteries.
Lupus nephritis.
Thromboembolism of the pulmonary arteries.
Unstable angina.
Pathological lesions of peripheral veins.
Embolization accompanying atrial fibrillation.
Arrhythmia.
Disorders of blood flow in the kidney area.
Disorders of blood microcirculation processes.
Bronchial asthma.
Rheumatism.
Some types of heart defects.
Hemolyticouremic syndrome.

Heparin reduces the risk of sudden death in patients suffering from myocardial infarction or coronary artery thrombosis.

Heparin injections provide a good effect as a prophylactic agent that prevents the development of venous thrombophlebia after surgical interventions.

Contraindications

Pulmonary infarction.
Individual intolerance to certain components of the drug.
Bleeding.
Thrombocytopenia (reduced blood clotting).
Hemorrhagic diathesis.
Hemophilia.
Increased permeability of blood vessels.
Werlhof's disease.
Aplastic anemia.
Leukemia in acute or chronic form.
Venous gangrene.
Hypoplastic anemia.
Kidney failure.
Liver pathologies.
Acute cardiac aneurysm.
Ulcerative lesions of the stomach and duodenum.
Arterial hypertension in severe form.
Previous surgical interventions in the area of the brain, visual apparatus, prostate gland.
Hemorrhagic stroke.
Recent spinal cord puncture.
Polyvalent allergy.
Ulcerative colitis.
The presence of tumor neoplasms of an oncological nature in the gastrointestinal tract.
Varicose veins of the esophagus.
Traumatic brain injury.

This medicine is used with extreme caution during pregnancy and breastfeeding. Typically, the drug is prescribed only in exceptional cases, when its benefit to the mother greatly outweighs the possible harm to the child.

Side effects

In some cases, the use of Heparin injections can lead to the development of the following undesirable reactions:

allergy;
hives;
thrombocytopenia;
rhinitis;
bronchial spasms;
bleeding;
formation of hematomas (especially in the case of intramuscular administration of Heparin);
osteoporosis;
nausea;
bouts of vomiting;
headaches reminiscent of migraine in nature;
disruption of digestive processes;
diarrhea;
fever;
necrosis of the skin;
disruption of calcium distribution processes in the soft tissue area;
hyperemia.

It is worth noting that in most cases, the development of the above side effects is observed with prolonged and uncontrolled use of Heparin. In order to minimize risks, the therapeutic course must be carried out exclusively as prescribed by a doctor and under his strict supervision.

Types of injections

The instructions for use of Heparin state that the dosage and duration of treatment depend on the disease, its severity and are prescribed individually in each specific case. The drug is administered intravenously, subcutaneously or intramuscularly. The fastest effect is observed with intramuscular injections (approximately after 30 minutes). In the case of subcutaneous administration, the effect occurs after 1 hour.

It is strictly contraindicated to give injections in the same place, as well as to take any medications without permission, since Heparin actively reacts with a wide range of drugs.

In the case of a long therapeutic course, it is necessary to monitor the clinical picture of the blood by conducting regular blood tests.

Heparin injections are a very effective drug that promotes the prevention and accelerated treatment of a number of diseases.

Heparin

Description current as of 08/04/2016

Latin name: Heparin
ATX code: C05BA03
Active ingredient: Heparin sodium (Heparin sodium)
Manufacturer: Synthesis OJSC, Murom Instrument-Making Plant, Tatkhimfarmpreparaty, Microgen NPO FSUE, Armavir Biofactory, Slavyanskaya Pharmacy FC LLC, Moscow Endocrine Plant (Russia), Belmedpreparaty RUP (Republic of Belarus)

Compound

The injection solution contains sodium heparin at a concentration of 5 thousand units/ml. The auxiliary components of the drug include sodium chloride, benzyl alcohol, and water.

1 gram of gel contains 1 thousand units of sodium heparin, as well as auxiliary components: 96% ethanol, carbomer, dimethyl sulfoxide, propylene glycol, dietanolamine, methyl and propylparaben (additives E 218, E 216), lavender oil and purified water.

Release form

Gel for external use 1 thousand units/g (ATC code - C05BA03). Tubes 30 g.
Solution for 5 thousand units/ml, 1 and 2 ml in ampoules No. 10, 2 and 5 ml in ampoules No. 5, 5 ml in bottles No. 1 and No. 5.

pharmachologic effect

Pharmacological group: anticoagulants.

Group of the drug Heparin, produced in the form of a gel: drugs for the treatment of cardiovascular diseases.

Group of the drug Heparin, produced in injection form: agents affecting blood and hematopoiesis.

Pharmacodynamics and pharmacokinetics

What is Heparin?

Heparin (INN: Heparin) is an acidic mucopolysaccharide with Mr about 16 kDa. A direct anticoagulant that helps slow down the formation of fibrin.

The gross formula of heparin is C12H19NO20S3.

Pharmacodynamics

The mechanism of action of heparin is based primarily on its binding to AT III (its plasma cofactor). Being a physiological anticoagulant, it potentiates the ability of AT III to suppress activated coagulation factors (in particular, IXa, Xa, XIa, XIIa).

If used in high concentrations heparin also inhibits thrombin activity.

Suppresses activated factor X, which is involved in the internal and external blood coagulation system.

The effect occurs when significantly lower doses of heparin are used than are required to inhibit the activity of coagulation factor II (thrombin), which promotes the formation of fibrin from the plasma protein fibrinogen.

This justifies the possibility of using small doses of heparin (subcutaneously) in for preventive purposes, and large ones - for treatment.

Heparin is not a fibrinolytic (that is, it is capable of dissolving blood clots), but it can reduce the size of the blood clot and stop its expansion. Thus, the blood clot is partially dissolved under the action of fibrinolytic enzymes of natural origin.

Suppresses the activity of the enzyme hyaluronidase, helps reduce the activity of surfactant in the lungs.

Reduces the risk of developing MI, acute thrombosis myocardial arteries and sudden death. In small doses it is effective for the prevention of VTE, in high doses it is effective against venous thrombosis and pulmonary embolism.

Deficiency of AT III at the site of thrombosis or plasma may reduce the antithrombotic effect of the drug

When applied externally, the product has a local anti-exudative, antithrombotic and moderate anti-inflammatory effect.

Promotes the activation of fibrinolytic properties of blood, inhibits the activity of hyaluronidase, and blocks the formation of thrombin. Gradually released from the gel and passing through the skin, heparin helps reduce inflammation and has an antithrombotic effect.

At the same time, the patient’s microcirculation improves and tissue metabolism is activated and, as a result, the processes of resorption of blood clots and hematomas are accelerated, and tissue swelling is reduced.

Pharmacokinetics

When used externally, absorption is negligible.

After injection under the skin TCmax hours. Up to 95% of the substance is in a state bound to plasma proteins, Vp - 0.06 l/kg (the substance does not leave the vascular bed due to strong binding to plasma proteins).

It does not penetrate the placental barrier or into breast milk.

Metabolized in the liver. The substance is characterized by rapid biological inactivation and short duration of action, which is explained by the participation of the antiheparin factor in its biotransformation and the binding of heparin to the macrophage system.

T1/minute. Excreted by the kidneys. Up to 50% of the substance can be excreted unchanged only if high doses are used. It is not excreted by hemodialysis.

Indications for use

Indications for use of the gel

Heparin gel is used for the treatment and prevention of thrombophlebitis of the superficial veins, phlebitis (post-injection and post-infusion), lymphangitis, superficial periphlebitis, elephantiasis, localized infiltrates, bruises, swelling and injuries (including muscles, joints, tendons), superficial mastitis, subcutaneous hematomas.

Indications for use of the solution

Heparin injections are prescribed for thrombosis of deep veins, myocardial arteries, renal veins, pulmonary embolism, thrombophlebitis, atrial fibrillation (including if the heart rate accompanied by embolization), unstable angina, disseminated intravascular coagulation syndrome, acute MI, mitral heart disease (prevention of blood clots), bacterial endocarditis, hemolyticouremic syndrome, lupus nephritis, glomerulonephritis, for the prevention and treatment of microthrombosis and microcirculation disorders.

For preventive purposes, the drug is used during surgical interventions that use extracorporeal blood circulation methods, during cytapheresis, peritoneal dialysis, hemodialysis, forced diuresis, hemosorption, and when washing venous catheters.

When Heparin is administered intravenously, blood clotting slows down almost immediately, when administered into a muscle - after a minute, when administered under the skin - after a minute, when inhalation method application, the effect is most pronounced after 24 hours.

Contraindications

Heparin gel (ointment) should be used with caution in case of thrombocytopenia and increased tendency to bleeding.

Contraindications for use injection form drug:

hypersensitivity;
diseases accompanied by increased bleeding (vasculitis, hemophilia, etc.);
bleeding;
aortic dissection, intracranial aneurysm;
antiphospholipid syndrome;
traumatic brain injury;
hemorrhagic stroke;
uncontrolled hypertension;
cirrhosis of the liver, accompanied by pathological changes in the veins of the esophagus;
threatened miscarriage;
menstrual period;
pregnancy;
childbirth (including recent);
lactation period;
erosive and ulcerative lesions of the stomach and intestinal tract;
recent surgical interventions on the prostate gland, brain, eyes, bile ducts and liver, as well as the condition after lumbar puncture.

Heparin injections should be prescribed with caution to patients with polyvalent allergies (including bronchial asthma), diabetes mellitus, arterial hypertension, active tuberculosis, endo- and pericarditis, chronic renal failure, liver failure; patients undergoing dental procedures or radiation therapy; persons over 60 years of age (especially women); women using an IUD.

Side effects

When used externally, Heparin sodium can cause skin hyperemia and hypersensitivity reactions.

When administering the solution, the following are possible:

Hypersensitivity reactions (drug fever, hyperemia skin, rhinitis, feeling of heat in the soles, urticaria, itching, collapse, bronchospasm, anaphylactic shock).
Headaches, dizziness, diarrhea, loss of appetite, nausea, vomiting;
Thrombocytopenia (in approximately 6% of patients), sometimes (rarely) - with fatal. Heparin-induced thrombocytopenia (HIT) is accompanied by: arterial thrombosis, skin necrosis and gangrene, stroke, myocardial infarction. In case of severe HIT (when the platelet count is reduced to half the original number or below 100 thousand/μl), heparin should be stopped immediately.
Local reactions (hematoma, hyperemia, pain, ulceration, irritation at the injection site, bleeding).
Bleeding. Typical ones are considered to be from the urinary tract and gastrointestinal tract, in areas that are subject to pressure, at the site of drug administration, from surgical wounds. Hemorrhages are also possible in various internal organs: in the retroperitoneal space, corpus luteum, adrenal glands, etc.

Against the background of long-term use of Heparin, intermittent alopecia, osteoporosis, hypoaldosteronism develop, and calcification occurs. soft fabrics, spontaneous bone fractures occur, and the activity of liver transaminases increases.

Instructions for use of Heparin (Method and dosage)

Heparin injections, instructions for use, administration features

Heparin in ampoules is prescribed in the form of:

regular injections into a vein;
continuous infusion;
subcutaneously (injections in the stomach).

For preventive purposes, sodium heparin is administered subcutaneously at a dose of 5 thousand IU/day, leaving 8-12 hours between injections (to prevent thrombosis, the patient is injected with 1 ml of solution under the skin of the abdomen 2 times/day).

For medicinal purposes, the solution is infused intravenously (the method of administration is drip infusion). Dose - 15 IU/kg/h (that is, for an adult with average weight body is prescribed 1 thousand IU/hour).

To achieve a rapid anticoagulant effect, 1 ml of solution is injected intravenously into the patient immediately before infusion. If administration into a vein is impossible for some reason, then the medicine is injected under the skin 4 times a day. 2 ml.

Highest daily dosage thousand. ME. Use Heparin in specified dose more than 10 days are allowed only in exceptional cases.

For children, the solution is injected into a vein by drip. The dose is selected depending on age: at the age of 1 to 3 months, the daily dose is IU/kg, from 4 months to a year, IU/kg, children over 6 years of age are prescribed (under APTT monitoring) 500 IU/kg/day.

Technique for administering Heparin, preparation for manipulation and administration of solution

Subcutaneous injections are usually given into the anterolateral wall of the abdomen (if this is not possible, the medicine can be injected into the upper thigh/shoulder area).

A thin needle is used for injection.

The first injection is given 1-2 hours before the start of the operation; in the postoperative period, the drug continues to be administered for 7-10 days (if necessary, longer).

Treatment begins with a jet injection of 5 thousand IU of heparin into a vein, after which the solution is continued to be administered using an intravenous infusion (a 0.9% NaCl solution is used to dilute the drug).

Maintenance doses are calculated depending on the route of administration.

The algorithm for administering Heparin is as follows:

One minute before administering the drug, apply cold to the injection site in the abdomen (this will reduce the likelihood of bruising).
The procedure is performed in compliance with the rules of asepsis.
The needle is inserted into the base of the fold (the fold is held between the thumb and forefinger until the end of drug administration) at an angle of 90°.
Do not move the tip of the needle after insertion or retract the piston. Otherwise, tissue damage and hematoma formation may occur.
The solution should be injected slowly (to reduce pain and avoid tissue damage).
The needle is removed easily, at the same angle at which it was inserted.
There is no need to wipe the skin; the injection site is lightly pressed with a sterile dry swab (the swab is held for a second).
It is recommended to alternate anatomical sites for injection. The areas in which injections are given during the week should be at a distance of 2.5 cm from each other.

Heparin ointment, instructions for use

The gel is used as an external agent. It should be applied to the affected area from 1 to 3 times a day. Single dose- column from 3 to 10 cm long.

For thrombosis of hemorrhoidal veins, the drug is used rectally.

Gel-impregnated cotton pads are applied to the inflamed nodes and secured with a bandage. Gel-soaked tampons are inserted into the anus. Treatment usually lasts 3-4 days.

For leg ulcers, the ointment is carefully applied to inflamed skin around the ulcer.

Multiplicity of applications / day. Treatment is continued until the inflammation disappears. Usually the course lasts from 3 to 7 days. The doctor decides whether a longer course is necessary.

Other heparin-containing ointments are used in a similar way (for example, the instructions for Heparin-Acrigel 1000 are practically no different from the instructions for Heparin gel or Lyoton 1000 gel).

For the treatment of hemorrhoids (external and internal), anal fissures, thrombophlebitis of the anal veins, as well as to relieve itching and eliminate eczema in the anal area, suppositories for hemorrhoids (for example, Hepatrombin G) can be used as an alternative to Heparin ointment.

Additional Information

Heparin is available only in the form of a solution, ointment or gel (gel, unlike ointment, contains a larger amount of active substance and is better absorbed into the skin).

Heparin tablets are not available because heparin is practically not absorbed from the digestive tract.

Overdose

Symptoms of overdose with parenteral use are bleeding varying degrees gravity.

Treatment: for minor bleeding caused by an overdose of the drug, it is enough to stop using it. If bleeding is extensive, protamine sulfate (1 mg per 100 IU of heparin) is used to neutralize excess heparin.

Please note that heparin is eliminated quickly. Thus, if protamine sulfate is administered 30 minutes after the previous dose of heparin, it should be administered at half the dose; The highest dose of protamine sulfate is 50 mg.

It is not excreted by hemodialysis.

Cases of overdose with external use of the drug have not been described. Due to the low systemic absorption of the drug, an overdose is considered unlikely. At long-term use on large surfaces, hemorrhagic complications are possible.

Treatment: discontinuation of the drug, if necessary, use of a one percent solution of protamine sulfate (heparin antagonist).

Interaction

Drugs that block tubular secretion, indirect anticoagulants that reduce the formation of vitamin K by intestinal microflora, antibiotics, NSAIDs, dipyridamole, ASA and other drugs that reduce platelet aggregation enhance the effect of heparin.

Do not mix the solution in the same syringe with other medications.

At local application the anticoagulant effect of the drug is enhanced when the gel is used in combination with antiplatelet agents, NSAIDs, and anticoagulants. Tetracycline, thyroxines, nicotine and antihistamines reduce the effect of heparin.

Terms of sale

The gel is an over-the-counter product; a prescription is required to purchase the solution.

Heparin recipe in Latin (sample):

S. IV food, first dilute the contents of the bottle in isotonic solution NaCl.

Storage conditions

Ampoules with solution should be stored in a dry place, protected from light, out of the reach of children.

The gel should be stored out of the reach of children at a temperature below 25˚C. Shelf life after opening - 28 days.

Best before date

special instructions

Due to the risk of hematoma formation at the injection site, the solution should not be injected into the muscle.

The solution may acquire a yellowish tint, which does not affect its activity or tolerability.

When prescribing the drug for therapeutic purposes, the dosage should be selected taking into account the aPTT value.

During treatment with the drug, organ biopsies and other medications should not be administered intramuscularly.

To dilute the solution, only 0.9% NaCl solution can be used.

The gel should not be applied to mucous membranes or open wounds. In addition, it is not used if there is purulent processes. The use of ointment is not recommended for DVT.

Unfractionated Heparin

Unfractionated is called Heparin with an average molecular weight thousand daltons, which are isolated from bovine lung or the mucous membrane of the intestinal tract of pigs. It is used in the production of drugs that provide local and systemic action(heparin containing ointments and solutions for parenteral administration).

The drug, through interaction with AT III (indirectly), inhibits the main enzyme of the blood coagulation system, as well as other coagulation factors, and this in turn leads to antithrombotic and anticoagulation effects.

Endogenous heparin human body can be found in muscles, intestinal mucosa, and lungs. In structure, it is a mixture of glycosaminoglycan fractions, which consist of sulfatide residues of D-glucosamine and D-glucuronic acid with a molecular weight of 2 to 50 thousand daltons.

Fractionated Heparin

Fractionated (low molecular weight) heparins are obtained by enzymatic or chemical depolymerization of unfractionated heparins. This Heparin consists of polysaccharides with an average molecular weight of thousands. Dalton.

LMWHs are characterized as weak anticoagulants and highly effective direct-acting antithrombotics. The action of such drugs is aimed at compensating hypercoagulation processes.

LMWH begins to act immediately after administration, while its antithrombotic effect is pronounced and prolonged (the drug is administered only 1 time per day).

Classification of low molecular weight Heparins:

Analogs

Use during pregnancy and lactation

Heparin solution is not contraindicated for pregnant women. However, despite the fact that active substance the drug does not penetrate into milk; its use in nursing mothers in some cases led to the rapid (within 2-4 weeks) development of osteoporosis and spinal damage.

The feasibility of use should be decided individually, taking into account the risk to the fetus/benefit to the mother ratio.

There are no data on the use of the gel during pregnancy and lactation.

Injection contains heparin sodium at a concentration of 5 thousand units/ml. The auxiliary components of the drug include sodium chloride, benzyl alcohol, and water.

In 1 gram gel contains 1 thousand units heparin sodium , as well as auxiliary components: 96% ethanol, dimethyl sulfoxide, propylene glycol, dietanolamine, methyl and propylparaben (additives E 218, E 216), lavender oil and purified water.

Release form

Gel for external use 1 thousand units/g (ATC code - C05BA03). Tubes 30 g.
Solution d/i 5 thousand units/ml, 1 and 2 ml in ampoules No. 10, 2 and 5 ml in ampoules No. 5, 5 ml in bottles No. 1 and No. 5.

pharmachologic effect

Pharmacological group: anticoagulants .

gel form: means for the treatment of cardiovascular diseases.

Group of the drug Heparin, produced in injection form: drugs affecting blood and hematopoiesis.

Pharmacodynamics and pharmacokinetics

What is Heparin?

Heparin (INN: Heparin) is an acidic mucopolysaccharide with Mr about 16 kDa. Direct anticoagulant that helps slow down the formation fibrin .

Gross formula of heparin: C12H19NO20S3.

Pharmacodynamics

The mechanism of action of heparin is based primarily on its binding to AT III (its plasma cofactor). Being physiological anticoagulant , it potentiates the ability of AT III to suppress activated coagulation factors (in particular, IXa, Xa, XIa, XIIa).

When used in high concentrations, heparin also inhibits thrombin activity .

Suppresses activated factor X, which is involved in the internal and external blood coagulation system.

The effect occurs when significantly lower doses of heparin are used than are required to inhibit the activity of coagulation factor II ( thrombin ), which promotes education fibrin from the plasma protein fibrinogen .

This justifies the possibility of using small doses of heparin (subcutaneously) for prophylactic purposes, and large doses for treatment.

Heparin is not fibrinolytic (i.e., is able to dissolve blood clots), but can reduce the size thrombus and stop its increase. Thus, the blood clot is partially dissolved under the action of fibrinolytic enzymes of natural origin.

Suppresses the activity of the enzyme hyaluronidase, helps reduce the activity of surfactant in the lungs.

Reduces the risk of developing MI, acute thrombosis of myocardial arteries and sudden death. In small doses it is effective for the prevention of VTE, in high doses it is effective for venous thrombosis And pulmonary embolisms .

Deficiency of AT III at the site of thrombosis or plasma may reduce the antithrombotic effect of the drug

When applied externally, the product has a local antiexudative , antithrombotic And moderate anti-inflammatory effect .

Pharmacokinetics

When used externally, absorption is negligible.

After injection under the skin, TCmax is 4-5 hours. Up to 95% of the substance is in a state bound to plasma proteins, Vp - 0.06 l/kg (the substance does not leave the vascular bed due to strong binding to plasma proteins).

It does not penetrate the placental barrier or into breast milk.

T1/2 - 30-60 minutes. Excreted by the kidneys. Up to 50% of the substance can be excreted unchanged only if high doses are used. It is not excreted by hemodialysis.

Indications for use

Indications for use of the gel

Gel Heparin used for treatment and prevention superficial veins , phlebitis (post-injection and post-infusion), lymphangitis, superficial periphlebitis, elephantiasis, localized infiltrates, bruises, swelling and injuries (including muscles, joints, tendons), superficial mastitis , subcutaneous hematomas .

Indications for use of the solution

Heparin injections prescribed when myocardial arteries , renal veins , TELA, thrombophlebitis , atrial fibrillation (including if cardiac arrhythmia is accompanied by embolization), unstable angina , DIC syndrome , acute MI, mitral heart disease (prevention of blood clots), bacterial endocarditis , hemolyticuremic syndrome , lupus nephritis , glomerulonephritis , for prevention and treatment microthrombosis and microcirculation disorders.

When Heparin is administered intravenously, blood clotting slows down almost immediately, when administered into a muscle - after 15-30 minutes, when administered subcutaneously - after 20-60 minutes, when administered by inhalation, the effect is most pronounced after 24 hours.

Contraindications

Heparin gel (ointment) should be used with caution when thrombocytopenia and increased tendency to bleeding.

Contraindications to the use of the injection form of the drug:

hypersensitivity;
accompanied by increased bleeding disease ( vasculitis ,hemophilia etc.);
bleeding;
, intracranial aneurysm;
antiphospholipid syndrome ;
traumatic brain injury;
hemorrhagic stroke ;
uncontrolled hypertension;
accompanied by pathological changes in the veins of the esophagus;
threatened miscarriage;
menstrual period;
pregnancy;
childbirth (including recent);
lactation period;
erosive and ulcerative lesions of the stomach and intestinal tract ;
recent surgical interventions on the prostate gland, brain, eyes, bile ducts and liver, as well as the condition after lumbar puncture.

Heparin injections should be prescribed with caution to patients with polyvalent allergy (including ), arterial hypertension , active , endo- and pericarditis , chronic renal failure, liver failure ; patients undergoing dental procedures or radiation therapy; persons over 60 years of age (especially women); women using an IUD.

Side effects

For external use Heparin sodium may cause skin hyperemia and hypersensitivity reactions.

When administering the solution, the following are possible:

Hypersensitivity reactions ( drug fever , hyperemia of the skin, rhinitis , feeling of heat in the soles, itching, collapse, bronchospasm , ).
Headaches, dizziness, diarrhea, loss of appetite, nausea, vomiting;
Thrombocytopenia (in approximately 6% of patients), sometimes (rarely) - with death. Heparin-induced thrombocytopenia (HIT) is accompanied by: arterial thrombosis , skin necrosis And , . In case of severe HIT (when the amount platelets decreases to half the original number or below 100 thousand/µl), heparin administration should be stopped immediately.
Local reactions ( hematoma , hyperemia , pain, ulceration, irritation at the injection site, bleeding).
Bleeding. Typical ones are considered to be from the urinary tract and gastrointestinal tract, in areas that are subject to pressure, at the site of drug administration, from surgical wounds. Also possible hemorrhages in various internal organs: retroperitoneal space, corpus luteum, adrenal glands, etc.

Against the background of long-term use of Heparin, incoming, hypoaldosteronism , soft tissues become calcified, spontaneous bone fractures occur, and the activity of liver transaminases increases.

Instructions for use of Heparin (Method and dosage)

Heparin injections, instructions for use, administration features

Heparin in ampoules is prescribed in the form of:

regular injections into a vein;
continuous infusion;
subcutaneously (injections in the stomach).

For medicinal purposes, the solution is infused intravenously (the method of administration is drip infusion). Dose - 15 IU/kg/h (that is, an adult with average body weight is prescribed 1 thousand IU/h).

To achieve fast anticoagulant effect 1 ml of solution is injected intravenously into the patient immediately before infusion. If administration into a vein is impossible for some reason, then the medicine is injected under the skin 4 times a day. 2 ml.

The highest daily dose is 60-80 thousand IU. The use of Heparin at the indicated dose for more than 10 days is permitted only in exceptional cases.

For children, the solution is injected into a vein by drip. The dose is selected depending on age: at the age of 1 to 3 months the daily dose is 800 IU/kg, from 4 months to a year - 700 IU/kg, children over 6 years of age are prescribed (under APTT monitoring) 500 IU/kg/ days

Technique for administering Heparin, preparation for manipulation and administration of solution

Subcutaneous injections are usually given into the anterolateral wall of the abdomen (if this is not possible, the medicine can be injected into the upper thigh/shoulder area).

A thin needle is used for injection.

The first injection is given 1-2 hours before the start of the operation; in the postoperative period, the drug continues to be administered for 7-10 days (if necessary, longer).

Maintenance doses are calculated depending on the route of administration.

The algorithm for administering Heparin is as follows:

15-20 minutes before administering the drug, apply cold to the injection site in the abdominal area (this will reduce the likelihood of bruising).
The procedure is performed in compliance with the rules of asepsis.
The needle is inserted into the base of the fold (the fold is held between the thumb and forefinger until the end of drug administration) at an angle of 90°.
Do not move the tip of the needle after insertion or retract the piston. Otherwise, tissue damage and hematoma formation may occur.
The solution should be injected slowly (to reduce pain and avoid tissue damage).
The needle is removed easily, at the same angle at which it was inserted.
There is no need to wipe the skin; the injection site is lightly pressed with a sterile dry swab (the swab is held for 30-60 seconds).
It is recommended to alternate anatomical sites for injection. The areas in which injections are given during the week should be at a distance of 2.5 cm from each other.

Heparin ointment, instructions for use

The gel is used as an external agent. It should be applied to the affected area from 1 to 3 times a day. A single dose is a column 3 to 10 cm long.

At thrombosis of hemorrhoidal veins the drug is used rectally.

Gel-impregnated cotton pads are applied to the inflamed nodes and secured with a bandage. Gel-soaked tampons are inserted into the anus. Treatment usually lasts 3-4 days.

At leg ulcer The ointment is carefully applied to the inflamed skin around the ulcer.

Frequency of applications - 2-3 rubles/day. Treatment is continued until the inflammation disappears. Usually the course lasts from 3 to 7 days. The doctor decides whether a longer course is necessary.

Additional Information

Heparin is available only in the form of a solution, ointment or gel (gel, unlike ointment, contains a larger amount of active substance and is better absorbed into the skin).

Heparin tablets are not available because heparin is practically not absorbed from the digestive tract.

Overdose

Symptoms of overdose with parenteral use are bleeding of varying severity.

Treatment: for minor bleeding caused by an overdose of the drug, it is enough to stop using it. If bleeding is extensive, heparin is used to neutralize excess protamine sulfate (1 mg per 100 IU of heparin).

Please note that heparin is eliminated quickly. Thus, if protamine sulfate prescribed 30 minutes after the previous dose of heparin, it must be administered at half the dose; highest dose protamine sulfate - 50 mg.

It is not excreted by hemodialysis.

Cases of overdose with external use of the drug have not been described. Due to the low systemic absorption of the drug, an overdose is considered unlikely. With prolonged use on large surfaces, possible hemorrhagic complications .

Treatment: discontinuation of the drug, if necessary, use of a one percent solution protamine sulfate (heparin antagonist).

Interaction

Drugs that block tubular secretion indirect anticoagulants Antibiotics, NSAIDs, ASA and other drugs that reduce platelet aggregation enhance the effect of heparin, which reduce the formation of vitamin K by intestinal microflora.

The weakening of the action is facilitated by: cardiac glycosides , ergot alkaloids ,phenothiazines , antihistamines, nicotine , ethacrine and nicotinic acid , nitroglycerine (iv injection), ACTH, tetracyclines , alkaline amino acids and polypeptides, thyroxine , protamine .

Do not mix the solution in the same syringe with other medications.

When applied topically, the anticoagulant effect of the drug is enhanced when the gel is used in combination with antiplatelet agents, NSAIDs, and anticoagulants. Tetracycline , thyroxines , nicotine And antihistamines reduce the effect of heparin.

Terms of sale

The gel is an over-the-counter product; a prescription is required to purchase the solution.

Heparin recipe in Latin (sample):

Rp: Heparini 5 ml
D.t. d. N. 5
S. IV 25,000 units, first dilute the contents of the bottle in an isotonic NaCl solution.

Storage conditions

Ampoules with solution should be stored in a dry place, protected from light, out of the reach of children.

The gel should be stored out of the reach of children at a temperature below 25˚C. Shelf life after opening - 28 days.

Best before date

Two years.

special instructions

Due to the risk of hematoma formation at the injection site, the solution should not be injected into the muscle.

The solution may acquire a yellowish tint, which does not affect its activity or tolerability.

When prescribing the drug for therapeutic purposes, the dosage should be selected taking into account the aPTT value.

During treatment with the drug, organ biopsies and other medications should not be administered intramuscularly.

To dilute the solution, only 0.9% NaCl solution can be used.

The gel should not be applied to mucous membranes or open wounds. In addition, it is not used in the presence of purulent processes. The use of ointment is not recommended for DVT.

Unfractionated Heparin

Heparin with an average molecular weight of 12-16 thousand daltons, which is isolated from bovine lung or the mucous membrane of the intestinal tract of pigs, is called unfractionated. It is used in the production of drugs that have local and systemic effects (heparin containing ointments and solutions for parenteral administration).

Endogenous heparin in the human body can be found in muscles, intestinal mucosa, and lungs. In structure, it is a mixture of glycosaminoglycan fractions, which consist of sulfatide residues of D-glucosamine and D-glucuronic acid with a molecular weight of 2 to 50 thousand daltons.

Fractionated Heparin

LMWHs are characterized as weak anticoagulants and highly effective direct-acting antithrombotics. The action of such drugs is aimed at compensating hypercoagulation processes.

LMWH begins to act immediately after administration, while its antithrombotic effect is pronounced and prolonged (the drug is administered only 1 time per day).

Classification of low molecular weight Heparins:

drugs used for prevention thrombosis/thromboembolism (Klivarin , Troparin etc.);
drugs used to treat unstable angina .
Generic injectable forms: Heparin J ,Heparin-Ferein , Heparin-Sandoz .

Drugs with a similar mechanism of action: tablets - Piyavit , Angioflux , ; solution - Angioflux , Antithrombin III human , Wessel Due F , Fluxum , Anfiber , Fraxiparine , .

Use during pregnancy and lactation

Heparin solution is not contraindicated for pregnant women. However, despite the fact that the active substance of the drug does not penetrate into milk, its use in nursing mothers in some cases led to the rapid (within 2-4 weeks) development osteoporosis and spinal damage.

The feasibility of use should be decided individually, taking into account the risk to the fetus/benefit to the mother ratio.

There are no data on the use of the gel during pregnancy and lactation.

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