Hepsal (Heparin Sodium)

Hepsal is indicated for several clinical situations where prevention or treatment of thrombotic events is required.

• Prevention and treatment of venous thromboembolism (VTE) in medical and surgical patients.
• Prophylaxis of deep‑vein thrombosis (DVT) in patients undergoing orthopedic or general surgery.
• Management of acute coronary syndromes, including unstable angina and myocardial infarction.
• Treatment of confirmed pulmonary embolism (PE) to restore pulmonary perfusion.
• Adjunct therapy during extracorporeal circulation procedures such as cardiopulmonary bypass.

Hepsal may cause a range of adverse reactions, which are generally classified by frequency and severity.

Common

• Minor bleeding at the injection site or from mucous membranes (e.g., nosebleeds, gum bleeding).
• Small bruising (ecchymosis) around the infusion site.
• Transient elevation of liver enzymes.
• Mild thrombocytopenia (low platelet count) detected on laboratory testing.
• Local irritation or pain at the catheter insertion point.

Serious

• Major hemorrhage, including intracranial or gastrointestinal bleeding.
• Heparin‑induced thrombocytopenia (HIT) with a paradoxical risk of clotting.
• Severe allergic reactions such as anaphylaxis or urticaria.
• Spontaneous spinal or epidural hematoma causing neurologic deficits.
• Disseminated intravascular coagulation (DIC) in rare cases.

Before using Hepsal, healthcare providers should evaluate patient‑specific factors and monitor for potential complications.

• Assess bleeding risk, including recent surgery, trauma, or active gastrointestinal ulceration.
• Obtain baseline complete blood count, especially platelet count, and repeat monitoring during therapy.
• Review renal and hepatic function, as impairment may affect drug clearance.
• Avoid use in patients with known hypersensitivity to heparin or pork‑derived products.
• Consider alternative anticoagulation in pregnancy unless benefits outweigh risks.
• Use caution in elderly patients due to increased bleeding susceptibility.

Hepsal can interact with other medications, altering anticoagulant effects or increasing bleeding risk.

Avoid

• Concurrent use with other anticoagulants (e.g., warfarin, direct oral anticoagulants) without close monitoring.
• Combination with antiplatelet agents such as aspirin, clopidogrel, or NSAIDs that amplify bleeding.
• Concomitant administration of fibrinolytic agents (e.g., alteplase, streptokinase).
• Use with high‑dose corticosteroids that may affect platelet function.

Use with caution

• Non‑steroidal anti‑inflammatory drugs (NSAIDs) at low doses, requiring periodic coagulation assessment.
• Certain antibiotics (e.g., vancomycin, ceftriaxone) that may potentiate anticoagulant effect.
• Herbal supplements such as ginkgo biloba, garlic, or fish oil that have mild antiplatelet activity.
• Proton pump inhibitors that may interfere with platelet aggregation.