THERAPEUTICS

Brands

• Hep-lock, Hepflush

Generic?

• Yes

Class

• Anticoagulant

Commonly Prescribed for

(FDA approved in bold)

• Deep venous thrombosis (DVT)/pulmonary embolism (PE)

• Atrial fibrillation with embolization

• Prevention of evolving thrombosis in acute ischemic stroke (AIS)

• Coagulopathies (acute and chronic)

• Prophylaxis against postoperative DVT/PE in at-risk patients

• Clotting prevention (i.e., during procedures)

• Prophylaxis of left ventricular thrombi and cerebrovascular accidents post-myocardial infarction (MI)

• Cerebral venous sinus thrombosis (CVST)

• During percutaneous coronary intervention (PCI), to mitigate plaque rupture and reduce thrombosis

• Unstable angina

How the Drug Works

• Inhibits multiple sites in the coagulation system, preventing normal clotting of blood and formation of fibrin clots. Heparin, in combination with antithrombin III, inactivates activated Factor X and prevents the conversion of prothrombin to thrombin

• Larger doses inhibit further coagulation by inactivating thrombin and preventing conversion of fibrinogen to fibrin and inhibiting the activation of fibrin stabilizing factor

How Long Until It Works

• IV bolus: anticoagulant effect is immediate but increases in proportion to dose and duration of use. SC: peak levels occur at 2–4 hours

If It Works

• Monitor for bleeding complications and check activated partial thromboplastin time (aPTT)

If It Doesn't Work

• Patients can still have DVT/PE or IS despite treatment. Check aPTT to determine effectiveness

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Often used with aspirin adjunctively in the setting of acute MI and coronary occlusion

• Usually used in acute setting after cardioembolic IS. Warfarin is usually used for long-term prophylaxis

Tests

• Monitor aPPT to determine effectiveness. Periodically monitor platelet counts and test for occult blood in stool

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• Anticoagulation increases bleeding risk, hypersensitivity accounts for most of the other AEs

Notable AEs

• Generalized hypersensitivity (chills, fever, urticaria, rhinitis, headache). Mild thrombocytopenia. Osteoporosis with extended use