prevention and treatment of venous thrombosis (including thrombosis of superficial and deep veins of the lower extremities, renal vein thrombosis) and pulmonary embolism;
prevention and treatment of thromboembolic complications associated with atrial fibrillation;
prevention and treatment of peripheral arterial embolism (including those associated with mitral heart disease);
treatment of acute and chronic consumption coagulopathies (including stage I DIC syndrome);
acute coronary syndrome without sustained ST-segment elevation on ECG (unstable angina pectoris, myocardial infarction without ST-segment elevation on ECG);
ST-segment elevation myocardial infarction with thrombolytic therapy, with primary percutaneous coronary revascularization (balloon angioplasty with or without stenting) and with a high risk of arterial or venous thrombosis and thromboembolism;
prevention and treatment of microthrombus formation and microcirculation disorders, including hemolytic uremic syndrome, glomerulonephritis (including lupus nephritis) and forced diuresis;
prevention of blood clotting during blood transfusion, in extracorporeal circulation systems (extracorporeal circulation during heart surgery, hemosorption, cytapheresis) and during hemodialysis;
Heparin sodium is given as a continuous intravenous infusion or as a subcutaneous or intravenous injection.
The initial dose of medicinal heparin sodium is 5000 IU and is given intravenously, after which treatment continues using subcutaneous injections or intravenous infusions.
Maintenance doses are determined depending on the method of administration:
- with continuous intravenous infusion, inject at a dose of 1000-2000 IU/hour (24000-48000 IU/day), diluting sodium heparin in 0,9% sodium chloride solution;
- with regular intravenous injections, 5000-10000 IU of sodium heparin is prescribed every 4-6 hours;
- for subcutaneous administration, it is administered every 12 hours at 15000-20000 IU or every 8 hours at 8000-10000 IU.
Primary percutaneous coronary angioplasty for acute coronary syndrome without ST-segment elevation and for myocardial infarction with ST-segment elevation
Heparin sodium is administered as an intravenous bolus at a dose of 70-100 U/kg (if the use of inhibitors of glycoprotein IIb/IIIa receptors is not planned) or at a dose of 50-60 U/kg (when used together with inhibitors of glycoprotein IIb/IIIa receptors)
Thrombolytic therapy for ST-segment elevation myocardial infarction
Heparin sodium is administered as an intravenous bolus at a dose of 60 U/kg (maximum dose of 4000 U), followed by intravenous infusion at a dose of 12 U/kg (not more than 1000 U/hour) for 24-48 hours. The target APTT level is 50-70 seconds or 1,5-2,0 times higher than normal; control of APTT 3, 6, 12 and 24 hours after the start of therapy
Prevention of thromboembolic complications after surgery using low doses of sodium heparin
Subcutaneously, deep into the fold of the abdominal skin. For the prevention of thrombus formation in the postoperative period, the first injection must be carried out 1-2 hours before the start of the operation; in the postoperative period, enter within 7-10 days, and if necessary, for a longer time. The initial dose is 5000 IU 2 hours before the start of the operation. In the postoperative period - 5000 IU every 8-12 hours for 7 days or until the patient's mobility is fully restored (whichever comes first). When using heparin sodium in low doses for the prevention of thromboembolic complications, it is not necessary to control the APTT
Application in cardiovascular surgery during operations using the extracorporeal circulation system
The initial dose is not less than 150 IU/kg. Next, sodium heparin is administered by continuous intravenous infusion at a rate of 15-25 drops/minute at 30 000 IU per 1 liter of infusion solution. The total dose is usually 300 IU/kg (if the estimated duration of the operation is less than 60 minutes) or 400 IU/kg (if the estimated duration of the operation is 60 minutes or more). Application in hemodialysis Initial dose - 25-30 U/kg (or 10 000 U) intravenously bolus, then continuous infusion of sodium heparin 20 000 IU/100 mg sodium chloride solution at a rate of 1500-2000 U/hour (unless otherwise indicated in the instructions for use systems for hemodialysis). The dose of sodium heparin should be adjusted based on blood coagulation parameters (target APTT level 60-85 seconds)
Switching to warfarin therapy
To ensure a persistent anticoagulant effect, the full dose of sodium heparin should be continued until a stable target INR is reached. After this, the administration of sodium heparin must be stopped
Switching to dabigatran therapy
Continuous intravenous administration of sodium heparin should be discontinued immediately after taking the first dose of dabigatran. In case of fractional intravenous administration, the patient should take the first dose of dabigatran orally 1-2 hours before the scheduled administration of the next dose of sodium heparin
The use of sodium heparin in pediatrics
Adequate controlled studies of the use of sodium heparin in children have not been conducted. The recommendations presented are based on clinical experience. The initial dose is 75-100 U/kg by intravenous bolus over 10 minutes. Maintenance dose: children aged 1-3 months - 25-30 U/kg/hour (800 U/kg/day), children aged 4-12 months - 25-30 U/kg/hour (700 U/kg/day), children over 1 year old - 18-20 U/kg/hour (500 U/kg/day) intravenously. The dose of sodium heparin should be adjusted based on blood coagulation parameters (target APTT level 60-85 seconds)
Laboratory monitoring of the efficacy and safety of sodium heparin therapy.
The dose of sodium heparin must be adjusted based on laboratory blood clotting parameters. When using heparin sodium, it is necessary to control the blood clotting time (RTC) and / or activated partial thromboplastin time (APTT). The administered dose of sodium heparin is considered adequate if the APTT is 1,5-2,5 times higher than the control values or if the patient's RVC is 2,5-3,0 times higher than the control values.
With continuous intravenous infusion of sodium heparin, it is recommended to determine the initial APTT, then determine the APTT every 4 hours with a subsequent increase or decrease in the rate of infusion of sodium heparin until the target level of APTT is reached (1,5-2,0 times higher than normal ), then determine APTT every 6 hours.
With an intravenous bolus of sodium heparin, it is recommended to determine the initial APTT, then to determine the APTT before each bolus administration, followed by an increase or decrease in the administered dose of sodium heparin.
With subcutaneous injection of sodium heparin, it is recommended to control APTT 4-6 hours after injection, followed by an increase or decrease in the administered dose of sodium heparin.
With the subcutaneous administration of small doses of sodium heparin (5000 IU 2-3 times a day) to prevent thrombus formation, it is not necessary to regularly monitor the APTT, since it increases insignificantly.
Continuous intravenous infusion is the most effective way of using sodium heparin, better than regular (intermittent) injections, as it provides more stable hypocoagulation and less frequent bleeding.
There are contraindications, consult with a specialist before use