Drug Detail:Heparin injection (Heparin (injection) [ hep-a-rin ])
Drug Class: Heparins
Usual Adult Dose for Deep Vein Thrombosis
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Deep Vein Thrombosis - Prophylaxis
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Prevention of Thromboembolism in Atrial Fibrillation
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Pulmonary Embolism
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Thrombotic/Thromboembolic Disorder
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Disseminated Intravascular Coagulation
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Venous Thromboembolism
The manufacturer provides the following dosing guidelines based on clinical experience:
Continuous IV infusion:
- Initial dose: 5000 units by IV injection
- Maintenance dose: 20,000 to 40,000 units per 24 hours by continuous IV infusion
Intermittent IV injection:
- Initial dose: 10,000 units IV
- Maintenance dose: 5000 to 10,000 units IV every 4 to 6 hours
Deep subcutaneous (intrafat) injection:
333 units/kg subcutaneously followed by 250 units/kg subcutaneously every 12 hours; the following dosage regimen has also been recommended: 5000 units by IV injection followed by 10,000 to 20,000 units subcutaneously, and then 8000 to 10,000 units subcutaneously every 8 hours or 15,000 to 20,000 units subcutaneously every 12 hours.
Comments:
- Recommended doses are based on a 68 kg patient.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
- Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation.
- Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation).
- Prophylaxis and treatment of peripheral arterial embolism.
5000 units subcutaneously 2 hours before surgery and 5000 units subcutaneously every 8 to 12 hours thereafter for 7 days or until the patient is ambulatory, whichever is longer.
Comments:
- Administer by deep subcutaneous (intrafat, e.g., above the iliac crest or abdominal fat layer, arm, or thigh) injection with a fine (25 to 26 gauge) needle to minimize tissue trauma.
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Use: Low-dose regimen for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients greater than 40 years old undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease.
Usual Adult Dose for Cardiothoracic Surgery
Initial dose: At least 150 units/kg; frequently, 300 units/kg is used for procedures estimated to last less than 60 minutes or 400 units/kg for those estimated to last longer than 60 minutes.
Comments:
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prevention of clotting in arterial and cardiac surgery.
- Total body perfusion for open-heart surgery.
Usual Adult Dose for Vascular Surgery
Initial dose: At least 150 units/kg; frequently, 300 units/kg is used for procedures estimated to last less than 60 minutes or 400 units/kg for those estimated to last longer than 60 minutes.
Comments:
- Consult the latest guidelines regarding duration and intensity of anticoagulation for the indicated conditions.
- Dosage and administration must be individualized according to the results of suitable laboratory tests.
Uses:
- Prevention of clotting in arterial and cardiac surgery.
- Total body perfusion for open-heart surgery.
Usual Adult Dose for Blood Transfusion
Addition of 400 to 600 USP units per 100 mL of whole blood is usually employed to prevent coagulation
Use: Anticoagulant use in blood transfusions.
Usual Adult Dose for Patency Maintenance of Indwelling Intravenous Devices
6 units/hr (using 2 units/mL formulation) has been found to be satisfactory
Comments: Rate of infusion depends upon age, weight, clinical condition, and procedure being employed.
Use: To aid in the maintenance of catheter patency.
Usual Pediatric Dose for Thrombotic/Thromboembolic Disorder
Neonates:
Systemic to pulmonary artery shunt thrombosis: 50 to 100 units/kg IV bolus; consideration should be given to ongoing infusion.
Central venous access device patency: 0.5 units/kg/hr IV continuous infusion
Systemic heparinization:
- Initial dose: 75 to 100 units/kg IV bolus over 10 minutes
- Maintenance dose: 25 to 30 units/kg/hr IV continuous infusion
Infants and Children:
Systemic to pulmonary artery shunt thrombosis: 50 to 100 units/kg IV bolus; consideration should be given to ongoing infusion.
Systemic to pulmonary artery shunt thromboprophylaxis: 10 to 15 units/kg/hr IV continuous infusion
Central venous line thromboprophylaxis in high-risk congenital heart disease (CHD) patients: 10 to 15 units/kg/hr IV continuous infusion
Systemic heparinization:
- Initial dose: 75 to 100 units/kg IV bolus over 10 minutes
- Maintenance dose: Infants: 25 to 30 units/kg/hr IV continuous infusion; Children: 18 to 20 units/kg/hr IV continuous infusion.
Comments:
- Use preservative-free formulations of this drug in neonates and infants.
- Adjust dose to maintain activated partial thromboplastin time (aPTT) of 60 to 85 seconds, assuming this reflects an anti-Factor Xa level of 0.35 to 0.7.
- Infants less than 2 months have the highest requirements (average dose of 28 units/kg/hr).
- Older children may require less of this drug, similar to weight-adjusted adult dosage.
Usual Pediatric Dose for Patency Maintenance of Indwelling Intravenous Devices
Neonates:
Systemic to pulmonary artery shunt thrombosis: 50 to 100 units/kg IV bolus; consideration should be given to ongoing infusion.
Central venous access device patency: 0.5 units/kg/hr IV continuous infusion
Systemic heparinization:
- Initial dose: 75 to 100 units/kg IV bolus over 10 minutes
- Maintenance dose: 25 to 30 units/kg/hr IV continuous infusion
Infants and Children:
Systemic to pulmonary artery shunt thrombosis: 50 to 100 units/kg IV bolus; consideration should be given to ongoing infusion.
Systemic to pulmonary artery shunt thromboprophylaxis: 10 to 15 units/kg/hr IV continuous infusion
Central venous line thromboprophylaxis in high-risk congenital heart disease (CHD) patients: 10 to 15 units/kg/hr IV continuous infusion
Systemic heparinization:
- Initial dose: 75 to 100 units/kg IV bolus over 10 minutes
- Maintenance dose: Infants: 25 to 30 units/kg/hr IV continuous infusion; Children: 18 to 20 units/kg/hr IV continuous infusion.
Comments:
- Use preservative-free formulations of this drug in neonates and infants.
- Adjust dose to maintain activated partial thromboplastin time (aPTT) of 60 to 85 seconds, assuming this reflects an anti-Factor Xa level of 0.35 to 0.7.
- Infants less than 2 months have the highest requirements (average dose of 28 units/kg/hr).
- Older children may require less of this drug, similar to weight-adjusted adult dosage.
Renal Dose Adjustments
Mild to moderate renal dysfunction: Data not available
Severe renal dysfunction: Use with caution
Liver Dose Adjustments
Use with caution
Dose Adjustments
Converting to warfarin: Continue full heparin therapy for several days until INR has reached a stable therapeutic range. Heparin may then be discontinued without tapering.
Converting to oral anticoagulants other than warfarin:
- Patients receiving heparin continuous IV infusion: Stop heparin immediately after administering the first dose of oral anticoagulant.
- Patients receiving heparin intermittent IV injection: Start oral anticoagulant 0 to 2 hours before the time the next dose of heparin was to have been administered.
Concomitant use of antithrombin III (human): In patients with antithrombin III deficiency, consider a lower dose of this drug when coadministered with antithrombin III (human).
Precautions
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Extracorporeal dialysis: If equipment manufacturers' recommendations are not available, the following doses are suggested based on pharmacodynamic data:
- Initial dose: 25 to 30 units/kg
- Maintenance dose: 1500 to 2000 units/hour
Peritoneal dialysis: Data not available
Other Comments
Administration advice: The manufacturer product information should be consulted.
Storage requirements: Storage of prepared infusion solution should not exceed 4 hours at room temperature or 24 hours at 2 to 8C.
Reconstitution/preparation techniques: The manufacturer product information should be consulted.
IV compatibility: The manufacturer product information should be consulted.
Monitoring:
- Gastrointestinal: Occult blood in stool (periodically throughout therapy)
- Hematologic: Coagulation tests (the manufacturer product information and institution-specific protocol should be consulted); hematocrit (periodically throughout therapy)
- Metabolic: Plasma potassium (in patients at risk of hyperkalemia before starting this drug and in all patients treated for more than 7 days)
Frequently asked questions
- How and where is Heparin injection given?
