Multiparin

Atrial fibrillation, Acute coronary syndrome, Unstable angina, Pulmonary embolism, Thromboembolism, Deep-vein thrombosis, Cardiopulmonary bypass, Hemofiltration, Peripheral arterial embolism

IV Preparation Recommended infusion concentration for most patients is 25,000 units in 500 mL D5W (50 units/mL premixed infusion solution) IV Administration IV injection may be given undiluted or diluted in 50-100 mL NS or D5W Infusion: Dilute in NS, D5W, or other compatible fluid Continuous IV therapy is preferred because intermittent IV therapy produces a higher incidence of bleeding abnormalities

DVT & Pulmonary Embolism Prophylaxis 5000 units Subcutaneous(SC) q8-12hr, OR 7500 units SC q12hr Treatment 80 units/kg IV bolus, THEN continuous infusion of 18 units/kg/hr, OR 5000 units IV bolus, THEN continuous infusion of 1300 units/hr, OR 250 units/kg (alternatively, 17,500 units) SC, THEN 250 units/kg q12hr Acute Coronary Syndromes PCI Without GPIIb/IIIa inhibitor: Initial IV bolus of 70-100 units/kg (target ACT 250-300 sec) With GPIIb/IIIa inhibitor: Initial IV bolus of 50-70 units/kg (target ACT >200 sec) STEMI Patient on fibrinolytics: IV bolus of 60 units/kg (max: 4000 units), THEN 12 units/kg/hr (max 1000 units/hr) as continuous IV infusion Dose should be adjusted to maintain aPTT of 50-70 sec Unstable Angina/NSTEMI Initial IV bolus of 60-70 units/kg (max: 5000 units), THEN initial IV infusion of 12-15 units/kg/hr (max: 1000 units/hr) Dose should be adjusted to maintain aPTT of 50-70 sec Anticoagulation Intermittent IV injection 8000-10,000 units IV initially, THEN 50-70 units/kg (5000-10,000 units) q4-6hr Continuous IV infusion 5000 units IV injection, followed by continuous IV infusion of 20,000-40,000 units/24 hr Catheter Patency Prevention of clot formation within venous and arterial catheters Use 100 units/mL; instill enough volume to fill lumen of catheter

Venous Thromboembolic Prophylaxis 100-150 units/kg IV once Venous Thromboembolic Treatment <1 year Loading dose of 75 units/kg IV, THEN 28 units/kg/hr IV as initial maintenance dose >1 year Loading dose of 75 units/kg IV, THEN 20 units/kg/hr IV as initial maintenance dose I ntermittent IV injection Initially give 50-100 units/kg IV infusion, THEN 100 units/kg IV infusion q4hr as a maintenance dose

Patients predisposed to active bleeding including thrombocytopenia, peptic ulcer disease, cerebrovascular disorders, haemorrhagic blood disorders, bacterial endocarditis, severe hypertension, oesophageal varices. Recent surgery at sites where haemorrhage would be an especial risk. Severe renal and hepatic impairment. Cerebral or subarachnoid haemorrhage, abdominal or thoracic bleeding into closed space, severe traumatic bleed, hepatic, renal, splenic or arterial injury, severe haemostatic defect, arterial thrombosis with heparin-associated thrombocytopenia. IM admin.

Heparin increases the inhibitory action of antithrombin III (AT III) on clotting factors XIIa, XIa, IXa, Xa and thrombin. This inhibits the conversion of prothrombin to thrombin and fibrinogen to fibrin. It also inhibits platelet function. It may reduce the activity of ATIII at very high doses.

Monitor platelet counts. Discontinue treatment if thrombocytopenia occurs. Hypersensitivity, elderly, pregnancy. Lactation: Not excreted in breast milk; compatible

>10% Heparin-induced thrombocytopenia, possibly delayed (10-30% ) Frequency Not Defined Mild pain,Hematoma,Hemorrhage,Local irritation,Erythema,Injection site ulcer (after deep SC injection),Increased liver aminotransferase,Anaphylaxis,Immune hypersensitivity reaction,Osteoporosis (long-term, high-dose use) Potentially Fatal: Heparin-induced thrombocytopenia with or without thrombosis; bleeding.

Enhanced anticoagulant effect w/ other drugs affecting platelet function or the coagulation system (e.g. platelet aggregation inhibitors, thrombolytic agents, salicylates, NSAIDs, vit K antagonists, dextrans, activated protein C). Decreased anticoagulant effect w/ gyceryl trinitrate infusion. Increased risk of hyperkalaemia w/ ACE inhibitors or angiotensin II antagonists.