Home Drug Guide Heparin Calcium

Drug Guide

Generic Name

Heparin Calcium

Brand Names Calciparine

Classification

Therapeutic: Anticoagulant, Antithrombotic

Pharmacological: Indirect Thrombin Inhibitor

FDA Approved Indications

Prevention and treatment of thromboembolic disorders, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and disseminated intravascular coagulation

Mechanism of Action

Heparin enhances the activity of antithrombin III, which inhibits thrombin and factor Xa, leading to decreased blood clot formation.

Dosage and Administration

Adult: Dosage varies based on condition; often an initial intravenous bolus of 5,000 units followed by continuous infusion titrated to activated partial thromboplastin time (aPTT) levels.

Pediatric: Dosing similar to adults, but requires careful monitoring; specific pediatric protocols should be followed.

Geriatric: Start at lower doses due to increased bleeding risk; monitor closely.

Renal Impairment: Adjust dosage with caution; heparin itself is not mainly eliminated by renal pathway.

Hepatic Impairment: No specific adjustment needed, but monitor for bleeding.

Pharmacokinetics

Absorption: Not absorbed orally; administered parenterally (IV or subcutaneous)

Distribution: Widely distributed in the extravascular space, does not cross the blood-brain barrier or placenta significantly

Metabolism: Metabolized by the reticuloendothelial system, primarily in the liver

Excretion: Cleared via the reticuloendothelial system; minimal renal clearance

Half Life: Approx. 1 to 2 hours after IV administration

Contraindications

Active major bleeding, severe thrombocytopenia (e.g., Heparin-Induced Thrombocytopenia, HIT), hypersensitivity to heparin or azure II dye

Precautions

History of HIT, bleeding disorders, recent surgeries, uncontrolled hypertension, during lumbar puncture or spinal anesthesia due to bleeding risk

Adverse Reactions - Common

Bleeding (Common)
Heparin-Induced Thrombocytopenia (HIT) (Uncommon but serious)
Elevated liver enzymes (Less common)

Adverse Reactions - Serious

Bleeding leading to hemorrhage (Serious, requires immediate attention)
HIT with thrombosis (Serious, can be life-threatening)
Osteoporosis with long-term use (Rare)

Drug-Drug Interactions

Other anticoagulants (e.g., warfarin, aspirin), antiplatelet agents, thrombolytics

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of bleeding, baseline aPTT, platelet counts, signs of HIT, neurological status, and extremity checks for thrombosis.

Diagnoses:

Risk for bleeding,

Implementation: Administer parenterally as prescribed, monitor coagulation parameters, watch for allergic reactions, ensure proper infusion techniques.

Evaluation: Effective anticoagulation confirmed by therapeutic aPTT levels, no bleeding complications, normal platelet counts.

Patient/Family Teaching

Report any signs of bleeding (unusual bruising, hematuria, blood in stool), or symptoms of thrombosis.
Inform about the importance of regular blood tests to monitor therapy.
Advise on avoiding injury and activities that may cause bleeding.

Special Considerations

Black Box Warnings:

Spinal/epidural hematoma risk with neuraxial anesthesia or puncture procedures.

Genetic Factors: Heparin resistance in some individuals, particularly with antithrombin deficiency.

Lab Test Interference: Can artificially elevate aPTT and interfere with certain coagulation tests.

Overdose Management

Signs/Symptoms: Uncontrolled bleeding, bruising, petechiae, hematuria, gastrointestinal bleeding.

Treatment: Discontinue heparin immediately, administer protamine sulfate (1 mg for every 100 units of heparin within the last 2-2.5 hours), supportive measures as needed.

Storage and Handling

Storage: Store at room temperature, protected from light, and moisture.

Stability: Stable until expiration date when stored properly.