Heparin

INTRODUCTION

Indications

Prophylaxis and treatment of various thromboembolic disorders, including Venous thromboembolism, pulmonary emboli, atrial fibrillation with embolization, acute and chronic consumptive coagulopathies, peripheral arterial thromboembolism. Used in very low doses (10–100 units) to maintain patency of IV catheters (heparin flush).

Action

Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. In low doses, prevents the conversion of prothrombin to thrombin by its effects on factor Xa. Higher doses neutralize thrombin, preventing the conversion of fibrinogen to fibrin. Therapeutic Effects: Prevention of thrombus formation. Prevention of extension of existing thrombi (full dose).

Adverse Reactions/Side Effects

GI: drug-induced hepatitis. Derm: alopecia (long-term use), rashes, urticaria. Hemat: BLEEDING, anemia, thrombocytopenia (can occur up to several weeks after discontinuation of therapy). Local: pain at injection site. MS: osteoporosis (long-term use). Misc: fever, hypersensitivity.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor symptoms of deep vein thrombosis (DVT) (pain, swelling, warmth, redness) to determine if drug therapy is effective in preventing or reducing venous thrombosis. Request or administer objective tests (Doppler ultrasound) if symptoms increase.

• In patients with DVT, watch for signs of pulmonary embolism, such as shortness of breath, chest pain, cough, and bloody sputum. Notify physician or nursing staff immediately if these signs occur.

• Assess for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, black/tarry stools, hematuria, and fall in hematocrit or blood pressure. Notify physician or nursing staff immediately if heparin causes excessive anticoagulation.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Be alert for acute arterial or venous thrombosis caused by heparin-induced thrombocytopenia (HIT). In certain patients, heparin initiates an immune reaction where antibodies attack circulating platelets. Although most cases of HIT are minor and asymptomatic, some patients may experience life- or limb-threatening platelet clots, resulting in myocardial infarction, ischemic stroke, acute leg ischemia, or venous thromboembolism. HIT can occur during and up to several weeks after heparin therapy. Any signs of increased clotting should be reported immediately.

• Watch for unusual weakness and fatigue that might be due to anemia. Report these signs to the physician or nursing staff.

• Monitor and report signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, skin rashes, flulike symptoms, and muscle/joint pain.

• Assess injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician or nursing staff.

Interventions

• Use caution with any physical interventions that ...