Hepalean , Heparin Sodium Lock Flush Solution, Hep-Lock
Classifications: anticoagulant; Therapeutic: anticoagulant
Pregnancy Category: C
10 units/mL, 100 units/mL, 1000 units/mL 2000 units/mL, 5000 units/mL, 10,000 units/mL, 20,000 units/mL, 40,000 units/mL
Exerts direct effect on the cascade of blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III
(heparin cofactor) on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin
to thrombin and fibrinogen to fibrin.
Inhibits formation of new clots. High molecular weight mucopolysaccharide with rapid anticoagulant effect. Does not lyse
already existing thrombi but may prevent their extension and propagation.
Prophylaxis and treatment of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising
from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in treatment of disseminated intravascular
coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, extracorporeal circulation,
and dialysis procedures.
Prophylaxis in hip and knee surgery. Heparin Sodium Lock Flush Solution is used to maintain potency of indwelling IV catheters
in intermittent IV therapy or blood sampling. It is not intended for anticoagulant therapy.
History of hypersensitivity to heparin (white clot syndrome); active bleeding, bleeding tendencies (hemophilia, purpura,
thrombocytopenia); jaundice; ascorbic acid deficiency; inaccessible ulcerative lesions; visceral carcinoma; open wounds,
extensive denudation of skin, suppurative thrombophlebitis; advanced kidney, liver, or biliary disease; active tuberculosis;
bacterial endocarditis; continuous tube drainage of stomach or small intestines; threatened abortion; suspected intracranial
hemorrhage, severe hypertension; recent surgery of eye, brain, or spinal cord; spinal tap; shock; pregnancy (category C),
especially the last trimester.
Alcoholism; history of allergy (asthma, hives, hay fever, eczema); during menstruation; immediate postpartum period; patients
with indwelling catheters; older adults; use of acid-citrate-dextrose (ACD)-converted blood (may contain heparin); patients
in hazardous occupations; cerebral embolism.
Route & Dosage
|Treatment of Thromboembolism
Adult: IV 5000-unit bolus dose, then 20,00040,000 units infused over 24 h, dose adjusted to maintain desired APTT or 500010,000
unit IV piggyback q46h SC 10,00020,000 unit followed by 800020,000 units q812h
Child: IV 50 unit/kg bolus, then 20,000 unit/m2/24 h or 50100 unit/kg q4h
Open Heart Surgery
Adult: IV 150400 units/kg
Prophylaxis of Embolism
Adult: SC 5000 units q812h until patient is ambulatory
- Note: Before administration, check coagulation test values; if results are not within therapeutic range, notify physician for
dosage adjustment. Do not use solutions of heparin or heparin lock-flush that contain benzyl alcohol preservative in neonates.
- Use more concentrated heparin solutions for SC injection.
- Make injections into the fatty layer of the abdomen or just above the iliac crest. Avoid injecting within 5 cm (2 in.) of
umbilicus or in a bruised area. Insert needle into tissue roll perpendicular to skin surface. Do not withdraw plunger to
check entry into blood vessel. Systematically rotate injection sites and keep record.
- Exercise caution to avoid IM injection.
PREPARE: Direct: Give undiluted. Intermittent/Continuous: ??May add to any amount of NS, D5W, or Ringer's for injection. ??Invert IV solution container at least 6 times to ensure adequate mixing.
ADMINISTER: Direct: Give a single dose over 60 sec. Intermittent/Continuous: Use infusion pump and give over 424 h.
INCOMPATIBILITIES Solution/additive: Alteplase, amikacin, atracurium, ciprofloxacin, codeine, cytarabine, dobutamine, doxorubicin, erythromycin, gentamicin, haloperidol, hyaluronidase, hydrocortisone, kanamycin, levorphanol, meperidine, methicillin, morphine, netilmicin, polymyxin B, promethazine, streptomycin, tetracycline, tobramycin, vancomycin. Y-site: Alteplase, amiodarone, amphotericin B cholesteryl, amsacrine, ciprofloxacin, clarithromycin, dacarbazine, diazepam, dobutamine, doxorubicin, doxycycline, droperidol, ergotamine, filgrastim, gatifloxacin, gentamicin, haloperidol, idarubicin, isosorbide, levofloxacin, methotrimeprazine, mexiletine, nitroglycerin, phenytoin, polymyxin B, tobramycin, tramadol, triflupromazine, vancomycin, vinorelbine.
- Store at 15°30° C (59°86° F). Protect from freezing.
Adverse Effects (≥1%)Hematologic: Spontaneous bleeding, transient thrombocytopenia,
hypofibrinogenemia, "white clot syndrome
." Body as a Whole:
Fever, chills, urticaria, pruritus, skin rashes, itching and burning sensations of feet, numbness and tingling of hands
and feet, elevated BP, headache, nasal congestion, lacrimation, conjunctivitis
, chest pains, arthralgia
, bronchospasm, anaphylactoid reactions. Endocrine:
Osteoporosis, hypoaldosteronism, suppressed renal
function, hyperkalemia; rebound hyperlipidemia (following termination
of heparin therapy). GI:
Increased AST, ALT. Urogenital:
Priapism (rare). Skin:
Injection site reactions: pain, itching, ecchymoses, tissue
irritation and sloughing; cyanosis and pains in arms or legs
(vasospasm), reversible transient alopecia
(usually around temporal area).
Diagnostic Test Interference
Notify laboratory that patient is receiving heparin, when a test is to be performed. Possibility of false-positive rise
in BSP test and in serum thyroxine; and increases in resin T3 uptake; false-negative 125I fibrinogen uptake. Heparin prolongs PT. Valid readings may be obtained by drawing blood samples at least 46 h after an IV dose (but at any time during heparin
infusion) and 1224 h after an SC heparin dose.
May prolong PT, which is used to monitor therapy with oral anticoagulants
; aspirin, nsaid
s increase risk of bleeding; nitroglycerin IV
may decrease anticoagulant activity; protamine
antagonizes effects of heparin. Herbal: Feverfew, ginkgo, ginger
may potentiate bleeding.
2060 min SC. Peak:
Within minutes. Duration:
26 h IV
; 812 h SC. Distribution:
Does not cross placenta; not distributed into breast milk. Metabolism:
In liver and by reticuloendothelial system. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Lab tests: Baseline blood coagulation tests, Hct, Hgb, RBC, and platelet counts prior to initiation of therapy and at regular
intervals throughout therapy.
- Monitor APTT levels closely.
- Note: In general, dosage is adjusted to keep APTT between 1.52.5 times normal control level.
- Draw blood for coagulation test 30 min before each scheduled SC or intermittent IV dose and approximately q4h for patients
receiving continuous IV heparin during dosage adjustment period. After dosage is established, tests may be done once daily.
- Patients vary widely in their reaction to heparin; risk of hemorrhage appears greatest in women, all patients >60 y, and
patients with liver disease or renal insufficiency.
- Monitor vital signs. Report fever, drop in BP, rapid pulse, and other S&S of hemorrhage.
- Observe all needle sites daily for hematoma and signs of inflammation (swelling, heat, redness, pain).
- Antidote: Have on hand protamine sulfate (1% solution), specific heparin antagonist.
Patient & Family Education
- Protect from injury and notify physician of pink, red, dark brown, or cloudy urine; red or dark brown vomitus; red or black
stools; bleeding gums or oral mucosa; ecchymoses, hematoma, epistaxis, bloody sputum; chest pain; abdominal or lumbar pain
or swelling; unusual increase in menstrual flow; pelvic pain; severe or continuous headache, faintness, or dizziness.
- Note: Menstruation may be somewhat increased and prolonged; usually, this is not a contraindication to continued therapy if bleeding
is not excessive.
- Learn correct technique for SC administration if discharged from hospital on heparin.
- Engage in normal activities such as shaving with a safety razor in the absence of a low platelet (thrombocyte) count. Usually,
heparin does not affect bleeding time.
- Caution: Smoking and alcohol consumption may alter response to heparin and are not advised.
- Do not take aspirin or any other OTC medication without physician's approval.