A Drug Study on

Heparin

In Partial Fulfillment of the

Requirements in NCM 209– RLE
OBSTETRIC AND GYNECOLOGY NURSING ROTATION

Submitted to:
Mrs. Vanessa Marie Y. Gambet, RN
Clinical Instructor

Submitted by:
Raijenne C. Versola, St.N

March 04, 2021

Generic Name: Heparin
Brand name: Heparin
Classification: anticoagulants
Mode of Action: Heparin interacts with the
naturally occurring plasma protein,
Antithrombin III, to induce a conformational
change, which markedly enhances
the serine protease activity of Antithrombin III,
thereby inhibiting the activated coagulation
factors involved in the clotting sequence,
particularly Xa and IIa
Dose and route:

Method of
Frequency Recommended Dose*
Administration

Intermittent
Initial Dose 10,000 units
Intravenous
Injection Every 4 to 6 hours 5,000 to 10,000 units

Continuous Initial Dose 5,000 units by intravenous injection

Intravenous
Continuous 20,000 to 40,000 units per 24 hours
Infusion

* Based on 150 lb. (68 kg) patient.

Indication:
Prophylaxis and treatment of venous thromboembolism and pulmonary
embolism;
Atrial fibrillation with embolization;
Treatment of acute and chronic consumptive coagulopathies
(disseminated intravascular coagulation);
Prevention of clotting in arterial and cardiac surgery;
 Prophylaxis and treatment of peripheral arterial embolism;
Anticoagulant use in blood transfusions, extracorporeal circulation, and
dialysis procedures.

Contraindication:
History of Heparin-Induced Thrombocytopenia (HIT) and Heparin-Induced
Thrombocytopenia and Thrombosis (HITT)
Known hypersensitivity to heparin or pork products
An uncontrolled bleeding state, except when this is due to disseminated
intravascular coagulation.

Side effects and adverse effects:

Side effects
Hemorrhage
Heparin-Induced Thrombocytopenia and Heparin-Induced
Thrombocytopenia and Thrombosis
Thrombocytopenia
Heparin Resistance
Hypersensitivity
Adverse effects
Heparin-induced thrombocytopenia, possibly delayed (10-30% )
Mild pain
Hemorrhage
Injection site ulcer (after deep SC injection)
Increased liver aminotransferase
Anaphylaxis
Immune hypersensitivity reaction
Osteoporosis (long-term, high-dose use)
Heparin resistance
Gasping syndrome in infants due to benzyl alcohol preservative
Hypersensitivity
 Necrosis of skin at site of subcutaneous injection
Local irritation, erythema, mild pain, hematoma or ulceration
following deep subcutaneous (intrafat) injection
Risk of serious adverse reactions in infants due to benzyl alcohol

Drug Interaction:
Oral Anticoagulants
Heparin sodium may prolong the one-stage prothrombin time.
Therefore, when heparin sodium is given with
dicumarol or warfarin sodium, a period of at least 5 hours
after the last intravenous dose or 24 hours after the last
subcutaneous dose should elapse before blood is
drawn if a valid prothrombin time is to be
obtained.
Platelet Inhibitors
Drugs such as NSAIDS, dextran, phenylbutazone, thienopyridines,
dipyridamole, hydroxychloroquine, glycoprotein
IIb/IIIa antagonists, and others that interfere
with platelet-aggregation reactions may induce
bleeding and should be used with
caution in patients receiving heparin sodium. To
reduce the risk of bleeding, a reduction in the dose of
antiplatelet agent or heparin is recommended.
Other Interactions
Digitalis, tetracyclines, nicotine, antihistamines, or intravenous
nitroglycerin may partially counteract the
anticoagulant action of heparin sodium.
Heparin Sodium In 5% Dextrose Injection
Intravenous nitroglycerin administered to heparinized patients may
result in a decrease of the partial thromboplastin time
with subsequent rebound effect upon discontinuation of
 nitroglycerin. Careful monitoring of partial
thromboplastin time and adjustment of heparin dosage
are recommended during coadministration of heparin and
intravenous nitroglycerin.
Antithrombin III (human)
The anticoagulant effect of heparin is enhanced by concurrent
treatment with antithrombin III (human) in patients
with hereditary antithrombin III deficiency. To reduce the
risk of bleeding, a reduced dosage of heparin is
recommended during treatment with antithrombin III
(human).

Nursing Responsibilities:
1. Inform patients that it may take them longer than usual to stop bleeding,
that they may bruise and/or bleed more easily when they are treated with
heparin, and that they should report any unusual bleeding or bruising to
their physician.

Rationale:  Hemorrhage can occur at virtually any site in patients receiving

heparin. Fatal hemorrhages have occurred.

2. Advise patients to inform physicians and dentists that they are receiving
heparin before any surgery is scheduled.

Rationale: The anticoagulant must be discontinued if the surgical bleeding

risk is high. Those at very high or high thromboembolic risk should limit
the period without anticoagulation to the shortest possible interval

3. Inform patients of the risk of heparin-induced thrombocytopenia (HIT)

 Rationale: Ensures patients understand the risks they undertake with
treatment.
4. If patient missed a dose, he/she must take his dose as soon as it was
remembered.

Rationale: Never try to catch up by taking two doses at once. This could
result in dangerous side effects, such as serious bleeding.

5. Don’t take heparin doses too much.

Rationale: Patient might have dangerous levels of the drug in their body,
which could lead to serious bleeding. This can be deadly. Symptoms of an
overdose of this drug can include: bruising easily, coughing up blood or
blood clots, and etc.

6. Do not let mother breastfeed infant when taking heparin.

Rationale: Some forms of heparin contain a preservative called benzyl

alcohol. This ingredient can slow down the central nervous system in
some infants. It has also caused trouble breathing and changes in the
blood chemistry in some infants. These effects can be deadly. If you
breastfeed your child, talk to your doctor about preservative-free heparin.

7. Inform patient with bleeding risk warning.

Rationale: This drug may cause serious bleeding. This happens because
this drug reduces your body’s ability to make your blood clot. Heparin may
cause you to bruise more easily. It also may take your body longer to stop
bleeding. This can cause death in rare cases. 
8. Inform patient with low platelet levels warning.

Rationale: This drug can decrease your platelet levels. This is known as
heparin-induced thrombocytopenia (HIT), which can eventually lead to the
formation of blood clots in your veins. These clots can form even several
weeks after you stop taking heparin.

9. Because of the risk of hemorrhage, advise patients to inform their

physicians and dentists of all medications they are taking, including non-
prescription medications, and before starting any new medication.

Rationale: To avoid further complications due to drug interactions.

10. Report important details to the CI/ attending physician.

Rationale: It is essential to report to the CI/ physician for them to be aware

of the actions taken and response of the patient’s body to the drug.
Bibliography:

RxList, Inc. (2020, October 27). Heparin. Retrieved March 3, 2021 from
https://www.rxlist.com/heparin-drug.htm#description.

University of Illinois. (2018, January 23). Heparin, Injectable Solution. Retrieved

March 3, 2021 from https://www.healthline.com/health/heparin-injectable
solution.

WebMD LLC. (2020). Heparin. Retrieved March 3, 2020 from

https://reference.medscape.com/drug/calciparine-monoparin-heparin
342169#11.