Heparin (Heparin Sodium)

Heparin is used in clinical practice to reduce the risk of thrombotic events in a variety of settings.

• Prevention and treatment of deep vein thrombosis (DVT)
• Prevention and treatment of pulmonary embolism (PE)
• Anticoagulation during cardiac surgery and cardiopulmonary bypass
• Management of acute coronary syndromes (unstable angina, NSTEMI)
• Prevention of clot formation in extracorporeal circuits such as dialysis or ECMO
• Bridging therapy when transitioning between oral anticoagulants

Heparin may cause a range of adverse reactions, most of which are related to its anticoagulant activity.

Common

• Minor bleeding at the injection site
• Nosebleeds (epistaxis)
• Small bruising or hematoma formation
• Mild thrombocytopenia (platelet count decrease)
• Elevated liver enzymes
• Transient rise in serum potassium

Serious

• Major hemorrhage (internal or external)
• Heparin‑induced thrombocytopenia (HIT) with paradoxical clotting
• Spinal or epidural hematoma when used near the central nervous system
• Severe allergic reactions (anaphylaxis)
• Acute adrenal insufficiency in rare cases

Before initiating heparin therapy, clinicians should evaluate patient‑specific risk factors and monitor laboratory parameters.

• Assess baseline coagulation status (aPTT, PT/INR) and platelet count
• Adjust dose in patients with renal or hepatic impairment
• Use caution in the elderly and those with a history of bleeding disorders
• Avoid use in patients with known hypersensitivity to heparin or pork products
• Monitor for signs of heparin‑induced thrombocytopenia (HIT) during treatment
• Consider pregnancy status; heparin is often preferred over warfarin but requires obstetric guidance

Heparin interacts with several medications that affect hemostasis or platelet function.

Avoid

• Concurrent use of other anticoagulants (warfarin, direct oral anticoagulants) without careful monitoring
• Dual antiplatelet agents (aspirin plus clopidogrel) that increase bleeding risk
• High‑dose fibrinolytic therapy (tPA) during acute thrombolysis

Use with caution

• Non‑steroidal anti‑inflammatory drugs (NSAIDs) and selective COX‑2 inhibitors
• Certain antibiotics (e.g., ceftriaxone) that may potentiate anticoagulation
• Thrombolytic agents at lower doses
• Herbal supplements such as ginkgo biloba, garlic, or ginger that affect platelet aggregation