Thrombocytopenia typically occurs in up to 30% of patients who receive heparin. Bleeding may also present as bruising, petechial rash, and nosebleeds. Patients should undergo monitoring for new bleeding that may present in the urine or stool. Bleeding is a major complication associated with heparin use. Heparin use's typical adverse effects include bleeding, thrombocytopenia, injection site reactions, and other adverse effects only seen with chronic heparin administration. Dependent upon the concentration, if instilling a lock flush, this could be close to a therapeutic dose of heparin in some pediatric patients. Extra caution should be observed in the administration of heparin lock solution frequently in a 24 hour period with pediatric patients. A small volume of heparin is instilled into the catheter tip and flushed daily. Lock flushes are usually dispensed as a 1 to 5 mL volume syringe used for catheter flush only. These are intended to maintain patency for IV lines and should not be used to achieve therapeutic anticoagulation. Due to the increase in adverse effects and exposure to heparin, these are not used as often in clinical practice. Heparin is also useful in smaller volumes as lock flushes. When heparin is administered and dosed by indication, there are no dosage adjustments required for renal dysfunction. For example, in patients with acute coronary syndrome or stroke, the dose is much lower due to an increased risk for bleeding. Dosing in some situations is much lower with different maximum doses. In obese populations, these dosages are capped off at a maximum bolus infusion and maximum infusion rate. Most heparin drips will be initiated with a bolus injection of 80 units/kilogram intravenously, followed by a continuous infusion rate of 18 units/kilogram/hour. ĭosing recommendations vary for each indication. The American College of Chest Physicians (ACCP) recommends using heparin for many other thrombotic states: atrial fibrillation undergoing cardioversion, endocarditis, systemic emboli, or venous thrombosis. During hospitalization, heparin will be used to bridge to oral anticoagulation, warfarin for mechanical and bioprosthetic valves. Heparin is widely used in the hospital for many different off-label indications, for example, patients who present with acute coronary syndromes (ACS) and who undergo percutaneous coronary intervention (PCI). Heparin can also be used to prevent excess coagulation during procedures such as cardiac surgery, extracorporeal circulation, or dialysis, including continuous renal replacement therapy (CRRT). Unfractionated heparin is an anticoagulant indicated for both the prevention and treatment of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as atrial fibrillation (AF).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |