Tab%25252525252525252525252525252525252525252520voihep

# Tabiohep (Heparin Sodium) ## Overview Heparin is a rapid-acting, parenteral anticoagulant that potentiates the action of antithrombin III, inactivating thrombin and activated factor X (Factor Xa). It is a high-alert medication with a narrow therapeutic index. ## Primary Indications * Prophylaxis and treatment of venous thromboembolism (VTE) and pulmonary embolism (PE). * Atrial fibrillation with embolization. * Prophylaxis of mural thrombus after myocardial infarction. * Anticoagulation in extracorporeal circulation (e.g., hemodialysis, cardiopulmonary bypass). * Prophylaxis/treatment of disseminated intravascular coagulation (DIC). ## Adult Dosing * **VTE Treatment (Weight-Based Protocol):** Initial bolus 80 units/kg IV, followed by continuous infusion of 18 units/kg/hr. * **Prophylaxis (SQ):** 5,000 units SQ every 8–12 hours. * *Note: Dosing strictly depends on institutional nomograms and clinical indication.* ## Pediatric Dosing * **Loading Dose:** 75 units/kg IV bolus over 10 minutes. * **Maintenance Infusion:** * Infants (<1 year): 25–30 units/kg/hr. * Children (≥1 year): 18–20 units/kg/hr. * *Note: Pediatric dosing requires frequent titration based on age and local hematology protocols.* ## Dose Adjustments * **Renal Impairment:** No standard adjustment required for dosage; however, monitor closely for bleeding, particularly in patients with severe impairment. * **Hepatic Impairment:** Use with caution; monitor coagulation parameters closely as clotting factor synthesis may be impaired. ## Contraindications * Known hypersensitivity to heparin or pork products. * Active major bleeding. * History of Heparin-Induced Thrombocytopenia (HIT). * Severe thrombocytopenia. * Conditions where blood coagulation tests cannot be performed at appropriate intervals. ## Adverse Effects * **Major:** Hemorrhage, Heparin-Induced Thrombocytopenia (HIT/HITT), hyperkalemia. * **Minor:** Injection site reaction, elevation of transaminases (AST/ALT), alopecia (long-term use), osteoporosis (long-term use). ## Key Drug Interactions * **Antiplatelet agents (e.g., aspirin, clopidogrel, NSAIDs):** Increased risk of hemorrhage. * **Thrombolytics:** Significantly elevated risk of severe bleeding. * **Anticoagulants (e.g., Warfarin, DOACs):** Additive bleeding risk; require careful transition protocols. ## Monitoring * **aPTT:** Monitor every 6 hours after initiation or dosage change until therapeutic range (usually 1.5–2.5x control) is reached; then daily. * **Anti-Factor Xa:** Recommended in pregnancy or where aPTT is unreliable. * **Platelet Count:** Baseline and every 2–3 days for the first 14 days to monitor for HIT. * **Hemoglobin/Hematocrit:** Monitor for occult or frank bleeding. ## Clinical Pearls * **Reversal:** Protamine Sulfate is the specific antidote. 1 mg of protamine neutralizes approximately 100 units of heparin; limit dose to 50 mg in a single dose. * **Flush vs. Therapeutic:** Ensure "Heparin Flush" (10-100 units/mL) is never confused with "Heparin Injection" (1,000-20,000 units/mL) to avoid fatal medication errors. * **HIT Awareness:** If platelets drop >50% from baseline or a new thrombus develops, discontinue all heparin and switch to a non-heparin anticoagulant (e.g., Argatroban). *** **Educational Disclaimer:** This information is for educational purposes only. Always consult the most current institutional protocols, prescribing information, and verify all calculations before medication administration.