Heparin Considerations for Use*
Non-FDA Approved Indication: Alternative to Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation
Mechanism of Action
Inhibits thrombin and factor Xa
Adult: 70 units/kg bolus, then 15 units/kg/hr infusion; adjust dose based on aPTT and hospital’s nomogram2
Elderly: No specific dosage adjustment
Hepatic Impairment: No specific dosage adjustment
Renal Impairment: No specific dosage adjustment
Active pathological bleeding, thrombocytopenia, history of heparin-induced thrombocytopenia
|Major Side Effects||
Hemorrhagic event, heparin-induced thrombocytopenia
|Dosage forms and Strengths||
IV: solution for injection
Discontinue heparin. Anticoagulation effects should be minimized within 3 hours; evaluate aPTT to confirm.
Protamine, given as a slow IV infusion (1 % solution), may largely neutralize heparin. Protamine 1 mg neutralizes ~ 100 units of heparin. Do not exceed protamine 50 mg. Monitor aPTT to confirm neutralization.
|Conversion to/from other drugs||
From heparin to warfarin:
Monitor aPTT, hemoglobin, hematocrit, platelets, stool for occult blood based on hospital’s nomogram.
May monitor anti-Xa (goal 0.3 to 0.7 IU/mL antifact or Xa activity) as an alternative to aPTT monitoring.
May reverse anticoagulation effects with protamine.
Discontinue all heparin products when heparin induced thrombocytopenia is suspected or diagnosed.
Report signs and symptoms of bleeding (e.g., unexpected bleeding or bleeding that lasts a long time; red or black, tarry stool; pink or brown urine; unusual bruising; coughing up blood; vomiting blood or vomit that looks like coffee grounds; unexplained pain, swelling, or joint pain; unusual headaches, dizziness, or weakness; recurring nose bleeds)
*Refer to prescribing information for more complete information.
†Dosages given in the table may differ from those recommended by the manufacturers.
- American College of Cardiology (ACC), American Heart Association (AHA), and Heart Rhythm Society (HRS). 2011 ACCF/AHA/HRS Focused Update on the Management of Patients With Atrial Fibrillation (Update on Dabigatran). Washington, DC: American College of Cardiology Foundation. 2011.
- Chest Supplement, Antithrombotic Therapy and Prevention of Thrombosis, 9th edition, American College of Chest Physicians.