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Heparin Sodium is given intravenously, preferably by continuous infusion, or by deep subcutaneous injection. The usual practice is to give an initial intravenous injection of 12,500 units of heparin, followed by doses of 10,000 units every 4 hours to maintain the clotting time, tested not less than 3 hours after the last injection, at about 3 times the pretreatment figure. The dose for this purpose usually ranges from 6,000 to 12,000 units. For continuous infusion 10,000 to 20,000 units of heparin is added to 1 liter of Dextrose injection or Sodium chloride injection and started at about 20 drops per minute. A suggested initial dose for children is 50 units per kg body mass by intravenous infusion in Dextrose injection 5% increased to 100 units per kg every 4 hours to keep the clotting time at 20 to 30 minutes. It is advisable to only use high grade needles with a gauge of 22 to 25, when extracting from the vial. DO NOT USE PREVIOUSLY USED NEEDLES. Pain at the site of injection may be minimized by the addition of 2% solution of procaine hydrochloride. If blood transfusions are required during anticoagulant therapy, 3 units of heparin per ml may be added to the transfused blood in addition to the dose already being administered. Bleeding from the site of operation is unlikely if heparin is started after the fourth postoperative day.
For treatment of venous thromboembolism: an intravenous loading dose of 5,000 units (10,000 may be required in severe pulmonary embolism) is followed by continuous intravenous infusion of 1,000 to 2,000 units/hour or subcutaneous injection of 15,000 units every 12 hours. Alternatively, intermittent intravenous dose of 5,000 to 10,000 units every 4 to 6 hours undiluted or diluted in 50 to 100 ml of Dextrose 5% in water or Sodium Chloride 0.9% is suggested. Children and adolescents are given a lower intravenous dose followed by maintenance with continuous infusion of 15-25 units/kg/hour or subcutaneous injection of 250 units/kg every 12 hours.
For prophylaxis of postoperative venous thrombo-embolism: subcutaneous doses used are 5,000 units 2 hours before surgery then 8-12 hours for 7 days or until the patient is ambulant. Similar doses are used to prevent thromboembolism during pregnancy in women with a history of deep-vein thrombosis or pulmonary embolism; the dose may need to be increased to 10,000 units every 12 hours during the third trimester.
Treatment of thrombo-embolic disorders, such as deep vein thrombosis, acute arterial embolism or thrombosis, thrombophlebitis, pulmonary embolism, fat embolism. Prophylaxis of deep vein thrombosis and thromboembolic events.
Heparin sodium should not be used in patients with severe thrombocytopenia, in whom suitable blood coagulation tests e.g. the whole blood clotting time, partial thromboplastin time, etc. could not be performed at appropriate intervals (this contraindication refers to full-dose heparin; there is usually no need to monitor coagulation parameters in patients receiving low-dose heparin). Heparin sodium should not be used in patients with an uncontrollable active bleeding state, except when this is due to disseminated intravascular coagulation. Conditions where hemorrhage is a particular risk:
– Aneurysm, cerebral or aortic
– Risk of abortion
– Recent childbirth
– Severe vasculitis
– Active cavitating tuberculosis
– Visceral carcinoma if there is a possibility of intracranial metastasis
– Peptic ulceration
– During or after eye, brain or spinal cord surgery or trauma
– Prior to lumbar puncture or regional anesthetic block
– Surgical or traumatic wounds resulting in large open surfaces
– Severe renal function impairment
– Severe hepatic function impairment
– Esophageal varices
– Subacute bacterial endocarditis.
Hypersensitivity: Avoid use in hypersensitive patients unless benefits outweigh risks.