Heparin

Heparin is a drug to overcome and prevent blood clots that risk  causing blockage of blood vessels and endangering the patient. This drug is available in the form of injections, gels, and ointments that must be used according to a doctor's prescription.

Heparin is one of the anticoagulant drugs or often referred to as blood thinners. This drug works by inhibiting the activity of several proteins that play a role in the blood clotting process .

Heparin can prevent blood clotting and stop the blood clotting process that has occurred. However, this medicine cannot eliminate or shrink blood clots that have formed.

Heparin trademarks:  Clotastop, Heparinol, Heparin Sodium, Hepagusan, Hico, Inviclot, Oparin, Thrombogel, Thrombophob, Thromboflash, Thromecon

What is Heparin

Warnings Before Using Heparin

Heparin should not be used indiscriminately. There are several things that should be considered before using this medicine, among others:

• Do not use heparin if you are allergic to this drug. Tell your doctor about any allergies you have.
• Tell your doctor if you have had uncontrolled bleeding or have a blood clotting disorder caused by certain conditions, such as thrombocytopenia or hemophilia .
• Tell your doctor if you have had or are currently suffering from heart disease, such as endocarditis , heart failure, or heart attack. Also let us know if you have hypertension and are on a low-salt diet.
• Tell your doctor if you have had or are currently suffering from liver disease, gastrointestinal bleeding , kidney disease, gastric ulcer, duodenal ulcer, cancer, hyperkalemia , diabetes mellitus, or metabolic acidosis .
• Tell your doctor if you are experiencing menstruation, fever, or an infectious disease.
• Do not consume alcoholic beverages during treatment with heparin because it can increase the risk of bleeding in the stomach.
• Consult a doctor about the use of heparin in the elderly (over 60 years old), especially women.
• Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant.
• Tell your doctor if you have recently undergone surgery, especially in the area of ​​the brain, spine, or eyes, before consuming heparin. Also let us know if you have recently undergone certain medical procedures, such as lumbar puncture or spinal anesthesia procedures .
• Inform your doctor that you are taking heparin if you are scheduled to undergo certain operations or medical procedures during treatment.
• Do not smoke during treatment with heparin, because smoking can reduce the effectiveness of heparin in the body.
• Tell your doctor if you are using other drugs, including supplements and herbal products, to anticipate drug interactions.
• Do not use heparin gel or ointment on open wounds or mucous membranes, such as the eyes or the inside of the nose and mouth.
• See a doctor immediately if an allergic drug reaction, more serious side effect, or overdose occurs after using heparin.

Heparin Dosage and Administration

The following is the division of heparin dosage based on the form of the drug and the purpose of the treatment:

1. Injectable heparin

Intravenous injection (intravenous/IV)

Purpose: Post-therapy treatment of heart attack with thrombolytic drugs

• Adults: 60 units/kgBB, with a maximum dose of 4,000 units. Then, continued with an infusion of 12 units/kgBB per hour. The maximum dose is 1,000 units per hour, with a duration of treatment of 48 hours

Purpose: Treatment of embolism , unstable angina, and deep vein thrombosis ( DVT )

• Adults: Initial dose 75–80 units/kgBW or 5,000 units (10,000 units in severe pulmonary embolism). Extended dose by infusion of 18 units/kgBW or 1,000–2,000 units per hour. Alternative dose 5,000–10,000 units every 4–6 hours.
• Children: Initial dose 50 units/kgBW. Extended dose by infusion of 15–25 units/kgBW per hour.

Injection under the skin (subcutaneous/SC)

Purpose: Prevention of blood clots and postoperative embolism 

• Adults: 5,000 units given 2 hours before surgery, then every 8–12 hours for 7 days or until the patient can move.

Purpose: Treatment of venous embolism

• Adults: 15,000–20,000 units every 12 hours or 8,000–10,000 U every 8 hours.
• Children: 250 units/kgBB, 2 times a day.

For elderly patients, the dose of injectable heparin may be reduced from the usual dose, because the possibility of side effects is greater.

2. Heparin gel or ointment

Purpose: prevent and overcome thrombophlebitis

Apply heparin gel or ointment to the affected skin surface 2-3 times a day.

How to Use Heparin Correctly

Injectable heparin can only be given by a doctor or medical personnel under the supervision of a doctor. Heparin injections can be given through a vein (intravenous/IV) or under the skin (SC/subcutaneous).

If you are prescribed heparin in the form of gel or ointment, follow the doctor's recommendations and read the instructions for use on the packaging before using it. Do not increase or decrease the dose without first consulting a doctor.

Apply thinly on areas of the skin that have blood clots or bruises. Use heparin gel or ointment at the same time every day for maximum effect.

If you forget to use heparin gel or ointment, it is recommended to use it immediately when the break with the next use schedule is not too close. If it's close, ignore it and don't double the dose.

During treatment with heparin, the doctor will advise the patient to perform routine blood tests, in order to monitor the effects of blood thinning and possible side effects.

Store heparin at room temperature. Do not store it in a humid place or exposed to direct sunlight. Keep this medicine out of the reach of children.

Heparin Interactions with Other Drugs

The following are interactions that can occur if heparin is used with certain drugs:

• Increased risk of bleeding if used with warfarin, antiplatelet , salicylic acid, NSAIDs , dextran, or fibrinolytic drugs, such as alteplase
• Decreased effectiveness of heparin if used with nitroglycerin
• Increased risk of hyperkalemia if used with ACE inhibitors or angiotensin II receptor blockers ( ARBs )

Side Effects and Dangers of Heparin

Side effects that may arise after using heparin are:

• Pain, redness, or irritation at the injection site
• Hair loss
• Easy to bruise
• Bleeding from gums or wounds stops longer

Check with your doctor if the side effects do not subside or get worse. See a doctor immediately if you experience serious side effects, such as:

• Severe swelling at the injection site
• Frequent nosebleeds
• Menstruation that is prolonged or more than usual
• Dark colored urine
• Feces are black
• Black vomit like coffee grounds
• An annoying headache or dizziness
• Symptoms of infection, characterized by fever, chills, runny nose, or watery eyes
• Bone pain

Immediately go to the IGD if you experience a drug allergic reaction or more serious side effects, such as:

• Coughing up blood
• Shortness of breath, dizziness, restlessness, and sweating
• Skin color changes to dark or bluish in the hands or feet
• Chest pain or arrhythmia
• Confusion
• Numbness or weakness on one side of the body
• Difficult to speak
• Visual disturbances, especially those that occur suddenly
• Intense pain in the stomach, lower back, or groin
• Dizziness to the point of fainting