Heparin solution for intravenous and subcutaneous administration 5000 IU/ml 5 ml bottles 5 pcs. in Kolomna

Heparin solution for intravenous and subcutaneous administration 5000 IU/ml 5 ml bottles 5 pcs. in Kolomna

For medicinal purposes

Heparin is prescribed as a continuous intravenous infusion or as regular intravenous injections, as well as subcutaneously (in the abdomen).

For preventive purposes

— subcutaneously, 5000 IU/day, at intervals of 8–12 hours. The usual place for subcutaneous injections is the anterolateral abdominal wall (in exceptional cases, it is injected into the upper region of the shoulder or thigh), using a thin needle, which should be inserted deeply, perpendicularly , into a fold of skin, held between the thumb and index finger until the solution is injected. The injection sites should be alternated each time (to avoid the formation of a hematoma). The first injection must be performed 1–2 hours before the start of surgery; in the postoperative period - administered for 7-10 days, and if necessary - for a longer time.

The initial dose of heparin administered for therapeutic purposes is usually 5000 IU and is administered intravenously, after which treatment is continued using subcutaneous injections or intravenous infusions.

Maintenance doses are determined depending on the route of administration:

• for continuous intravenous infusion, 1000–2000 IU/hour (24000–48000 IU/day) is prescribed, diluting heparin with 0.9% sodium chloride solution;
• with regular intravenous injections, 5000–10000 IU of heparin is prescribed every 4–6 hours;
• for subcutaneous administration, 15,000–20,000 IU is administered every 12 hours or 8,000–10,000 IU every 8 hours.

Intravenous injections are recommended only for initial doses or if for some reason intravenous infusion or subcutaneous administration cannot be used. Repeated intravenous injections cause significant fluctuations in hemostasis and more often cause dangerous bleeding, so they are prescribed only when absolutely necessary.

For adults with thrombosis of mild to moderate severity, it is administered intravenously, 40,000–50,000 IU/day for 3–4 administrations; for severe thrombosis and embolism - 20,000 IU intravenously 4 times a day with an interval of 6 hours.

For health reasons, 25,000 IU is administered intravenously once, then 20,000 IU every 4 hours until a daily dose of 80,000–120,000 IU is reached. When administered intravenously, at least 40,000 IU is added to the daily volume of infusion solution.

The duration of heparin therapy depends on the indications and route of administration. For intravenous use, the optimal duration of treatment is 7–10 days, after which therapy is continued with oral anticoagulants (it is recommended to prescribe oral anticoagulants starting from the 1st day of heparin treatment or from 5 to 7 days, and stop the use of heparin on the 4–5 day of combination therapy) . In case of extensive thrombosis of the iliofemoral veins, it is advisable to carry out longer courses of treatment with heparin.

Laboratory monitoring of the effectiveness and safety of sodium heparin therapy

The dose of heparin sodium should be adjusted based on laboratory blood clotting parameters. When using heparin sodium, it is necessary to monitor the activated partial thromboplastin time (aPTT) or blood clotting time (BCT). The dose of heparin sodium administered is considered adequate if the aPTT is 1.5 to 2.0 times the normal value or if the patient's ICR is 2.5 to 3.0 times the control value.

With continuous intravenous infusion of heparin sodium, it is recommended to determine the initial aPTT, then determine the aPTT every 4 hours, followed by increasing or decreasing the rate of infusion of heparin sodium until the target aPTT level is achieved (1.5-2 times normal), then determine the aPTT every 6 hours .

When bolus intravenous administration of heparin sodium is recommended, it is recommended to determine the initial aPTT, then determine the aPTT before each bolus, followed by an increase or decrease in the administered dose of heparin sodium.

When administering sodium heparin subcutaneously, it is recommended to monitor the aPTT 4–6 hours after injection, followed by an increase or decrease in the administered dose of sodium heparin.

When using sodium heparin in low doses to prevent thromboembolic complications, it is not necessary to monitor the aPTT.

Continuous intravenous infusion is the most effective way of using sodium heparin, better than regular (periodic) injections, because provides more stable hypocoagulation and is less likely to cause bleeding.

Use of heparin sodium in special clinical situations

Primary percutaneous coronary angioplasty for acute coronary syndrome without ST segment elevation and myocardial infarction with ST segment elevation: sodium heparin is administered intravenously as a bolus at a dose of 70–100 IU/kg (if the use of glycoprotein IIb/IIIa receptor inhibitors is not planned) or at a dose of 50 –60 IU/kg (when used together with inhibitors of glycoprotein IIb/IIIa receptors).

Thrombolytic therapy for ST-segment elevation myocardial infarction: sodium heparin is administered as an intravenous bolus at a dose of 60 IU/kg (maximum dose 4000 IU), followed by intravenous infusion at a dose of 12 IU/kg (not more than 1000 IU/hour) for 24– 48 hours. The target APTT level is 50–70 sec or 1.5–2.0 times higher than normal; APTT monitoring 3, 6, 12 and 24 hours after the start of therapy.

Prevention of thromboembolic complications after surgery using low doses of sodium heparin:

subcutaneously, deep into the fold of the skin of the abdomen. The initial dose is 5000 IU 2 hours before surgery. In the postoperative period: 5000 IU every 8–12 hours for 7 days or until the patient’s mobility is completely restored (whichever comes first). When using sodium heparin in low doses to prevent thromboembolic complications, it is not necessary to monitor the aPTT.

When preventing thrombus formation in the postoperative period, the first injection should be performed 1–2 hours before the start of surgery; in the postoperative period, administer for 7–10 days, and, if necessary, for a longer period.

Application in cardiovascular surgery during operations using extracorporeal circulatory systems:

the initial dose of sodium heparin is not less than 150 IU/kg body weight. Next, sodium heparin is administered by continuous intravenous infusion at a rate of 15–25 drops/min, 30,000 IU per 1 liter of infusion solution. The total dose of heparin sodium is usually 300 IU/kg body weight (if the expected duration of the operation is less than 60 minutes) or 400 IU/kg body weight (if the expected duration of the operation is 60 minutes or more).

Use in hemodialysis:

Initial dose of heparin sodium: 25–30 IU/kg (or 10,000 IU) intravenous bolus, then continuous infusion of heparin sodium 20,000 IU/100 mg sodium chloride solution at a rate of 1500–2000 IU/hour (unless otherwise indicated in the instructions for use of the systems for hemodialysis).

Application in pediatrics:

Adequate controlled studies of the use of heparin sodium in children have not been conducted. The recommendations presented are based on clinical experience.

Initial dose: 75–100 IU/kg IV bolus over 10 minutes.

Maintenance dose: children aged 1-3 months - 25-30 IU/kg/hour (800 IU/kg/day), children aged 4-12 months - 25-30 IU/kg/hour (700 IU/kg/day day), children over 1 year - 18–20 IU/kg/hour (500 IU/kg/day) intravenously.

The dose of heparin sodium should be adjusted based on coagulation parameters (target aPTT 60–85 seconds).

Switching to warfarin therapy: To ensure a sustained anticoagulant effect, therapy with heparin sodium at full dose should be continued until a stable target INR level is achieved. After this, the administration of sodium heparin must be stopped.

Switching to dabigatran therapy: Continuous intravenous heparin sodium should be discontinued immediately after the first dose of dabigatran. With divided intravenous administration, the patient should take the first dose of dabigatran orally 1–2 hours before the scheduled administration of the next dose of sodium heparin.

Release form and composition of the drug

The medicine Heparin is produced in several dosage forms. These include:

• Heparin solution;
• ointment;
• gel.

Heparin injection solution has a clear or light yellowish tint, odorless, and is available in ampoules of 5 and 10 pieces in a cardboard box.

The ointment is packaged in aluminum tubes of 10 or 25 g. Each of which is placed in a cardboard package, including an insert with instructions for use.

The gel is produced in tubes with different dosages, packaged in 15, 20, 30, 50 and 100 g. Each package contains an annotation on the use of the drug.

The drug Heparin includes the main active ingredient - heparin and auxiliary components.

Analogs

The RLS list includes many drugs that have a similar effect and composition to Heparin. Analogues include:

• Viatromb - contains sodium heparin and is available in the form of a gel and spray for local treatment of affected areas;
• Heparin Akrikhin is an anticoagulant gel used to eliminate heaviness in the legs, swelling, and varicose veins. Heparin Akriquin causes side effects if used incorrectly, so it is recommended to use the medicine with a doctor’s prescription;
• Gel Lyoton - contains the same active substance, in medical practice it is used to treat diseases of the superficial veins, accompanied by the formation of blood clots and changes in the structure of blood vessels;
• Trombless gel - belongs to the group of direct anticoagulants, has anti-edematous, antithrombotic, anti-inflammatory effects;
• Heparin Sandoz is a solution for injection, used to treat and prevent the formation of blood clots in deep veins, to prevent pathological blood clotting during surgical interventions;
• Heparin Richter is a solution in ampoules used for the treatment and prevention of vascular diseases, including acute myocardial infarction.

Important! You cannot use the product in the form of an ointment and a solution at the same time, as this can cause an overdose.

Side effects

Side effects of Heparin with proper use of the drug are quite rare, as evidenced by positive reviews from doctors and patients. Failure to follow the instructions for use may cause complications such as bleeding. More often, this consequence is diagnosed in people with impaired renal and liver function, among patients over 65 years of age.

Side effects from the use of the drug can be in the form of thrombocytopenia with vascular thromboembolism and hemorrhage. In most cases, this condition develops during drug therapy for 7 or more days.

The doctor is obliged to warn the patient about possible side effects

At the injection site, the patient may experience swelling, pain, and redness of the dermis. As a rule, after discontinuation of the drug, the negative consequences go away on their own and do not require special treatment.

Features of treatment

It is advisable to use heparin intravenously for a long time during hospital treatment.

The doctor must take into account the specifics of administering Heparin. Simultaneous intramuscular administration of other medications with Heparin solution is used extremely rarely, only if necessary.

If the effect of Heparin is absent when prescribing injections, it is important to monitor the level of antithrombin III in the patient’s blood.

Among people suffering from arterial hypertension, it is necessary to regularly monitor blood pressure.

The drug is prescribed with extreme caution among women who have intrauterine devices, with active tuberculosis, and during treatment with radiation therapy.

Among elderly patients, the dosage of the drug should be reduced, since standard doses of the drug increase the risk of bleeding.

The ointment or gel should not be applied to open wounds. Avoid contact of the product with the mucous membrane of the mouth, eyes, and genitals.

Use in pediatrics

Heparin for children in various release forms is prescribed by the attending physician if there are indications for use. Injections are often used to prevent blood clots after surgery. There are no age restrictions, but before reaching 3 years of age, injections are prescribed only if necessary.

The drug in the form of an ointment is prescribed to children from one year of age, despite the fact that the instructions prohibit the use of the drug under 3 years of age. If you are prone to bleeding or are at risk of developing it, Heparin is contraindicated in children.

Drug interactions

The therapeutic effect of the described medication is enhanced when combined with non-steroidal anti-inflammatory drugs and antiplatelet agents. When used simultaneously with Tetracycline, antiallergic drugs, nicotine, the effect of Heparin is reduced.

When using the drug, its drug interactions must be taken into account.

Use among pregnant women

Although heparin can cause unwanted side effects among pregnant women, the benefits of its use outweigh the risks in many situations.

It has been clinically proven that the active components of the product are not able to penetrate the placenta and therefore cannot harm the baby. It is important to note that this does not mean that you can use the medicine on your own. Only a doctor should prescribe the drug during this delicate period.

The course of treatment, lasting up to 7 days, does not require monitoring of the blood condition. If therapy takes more than a week, the patient must donate blood for laboratory testing.

The use of Heparin sometimes provokes a disturbance in the level of calcium in the body. During pregnancy, additional therapy may be needed, including medications and calcium supplements.

Pharmacodynamics

The pharmacological effect of the described drug lies primarily in the process of inhibiting the formation of fibrin. When Heparin is administered intravenously, the following effect is achieved:

• increased renal blood flow;
• increasing the resistance of cerebral vessels;
• decreased surfactant activity in lung tissues;
• decreased production of aldosterone by the adrenal cortex;
• preventing the formation of blood clots in the arteries;
• prevention of primary and recurrent myocardial infarctions;
• prevention of cases of sudden death of the patient.

The effect of the drug when used as an injection occurs quite quickly

The use of Heparin in the form of an ointment or gel makes it possible to relieve the inflammatory process in the affected areas and achieve resorption of blood clots and skin hematomas. As a result, existing blood clots dissolve, and new ones do not form. The mechanism of action of Heparin when used topically is to inhibit thrombin synthesis, reduce platelet aggregation, and suppress hyaluronidase activity.

Important! Both forms of release of the drug have their own indications for use and contraindications. The decision to prescribe this or that drug is made solely by the doctor.

Indications for use

The effect of Heparin in the form of injections or ointments for external use is somewhat different. Let's consider the indications for the use of various forms of drug release.

Heparin injections are indicated for patients with the following conditions:

• thrombosis of renal vessels;
• endocarditis of bacterial origin;
• lupus nephritis;
• preventing blood clots during surgery;
• mitral heart defects;
• undergoing hemodialysis;
• use in blood transfusion procedures.

Heparin is used to treat and prevent blood clots

The use of Heparin in the form of gel and ointment is indicated for the following conditions:

• treatment of thrombophlebitis of superficial vessels;
• external appearance of hemorrhoids;
• inflammation of hemorrhoidal veins after the birth process;
• trophic ulcers on the legs;
• superficial mastitis;
• treatment of subcutaneous hematomas;
• skin injuries not accompanied by open wounds on the body;
• damage to muscle fibers and tendons.

The ointment and gel can be used independently at home as prescribed by the attending physician. The drug is administered intravenously or intramuscularly exclusively by a medical professional.