Heparin

Heparin, containing the active ingredient heparin sodium, is an injectable anticoagulant supplied in an intravenous formulation. It is classified as an antithrombotic and antithrombotic drug (ATC code B01AB01) and is marketed in the European Union as a prescription‑only medication for preventing and treating clot‑related conditions.

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