Common name
Heparin sodium injection
English name
Heparin Sodium Injection
Component
The main component of this product is heparin sodium.
Character
This product is colorless or light yellow clear liquid.
Indication
This product is used for the prevention and treatment of thrombosis or embolism diseases (such as myocardial infarction, thrombophlebitis, pulmonary embolism, etc.); diffuse intravascular coagulation (DIC) caused by various reasons; it is also used in hemodialysis, extracorporeal circulation, catheterization, microvascular operation, and anticoagulation treatment of some blood samples or instruments.
Specifications
(1) 2ml: 1000 units; (2) 2ml: 5000 units; (3) 2ml: 12500 units.
Usage and dosage
1. Deep subcutaneous injection: 5000-10000 units for the first time, 8000-10000 units every 8 hours or 15000-20000 units every 12 hours; the total amount is about 30000-40000 units per 24 hours, which can generally achieve satisfactory results.
2. Intravenous injection: 5000-10000 units for the first time, and then, or diluted with sodium chloride injection according to the weight of 100 units / kg every 4 hours.
3. Intravenous drip: 20000-40000 units per day, added to 1000mi sodium chloride injection, continuous infusion. Intravenous injection of 5000 units can be used as the initial dose before infusion.
4. Preventive treatment: high risk thrombosis patients, mostly used after abdominal surgery, to prevent deep venous thrombosis. 5 000 units of heparin were injected subcutaneously 2 hours before surgery, but epidural anesthesia should be avoided, and then 5000 units were injected every 8-12 hours for about 7 days.
Clinical application and guidelines
1. Wang Feng, Wang Zhirong, Wang Qinghai, Wang Qingkai through Danzhi Tongmai formula combined with heparin sodium injection in the treatment of middle and low-risk acute pulmonary embolism syndrome score changes and the impact on right heart function, concluded that Danzhi Tongmai formula combined with heparin sodium injection can improve the right heart function of patients with middle and low-risk ape, significantly reduce the TCM syndrome shortness of breath, chest pain, cough score, and does not increase Blood risk. (Hebei Traditional Chinese medicine, 2018, 40 (12): 1775-1779)
2. Li Zejun through the Huoluo Zhuyu formula combined with low molecular weight heparin sodium injection in the prevention of deep vein thrombosis after hip arthroplasty, Li Zejun concluded that (1) the combination of Huoluo Zhuyu Decoction and low molecular weight heparin sodium injection can reduce the incidence of DVT in lower limbs of patients after total hip arthroplasty; (2) live Compared with LMWH alone, luozhuyu decoction combined with LMWH injection can significantly prolong the postoperative APTT and Pt time and reduce the content of D-dimer, so as to better improve the patients' blood in hypercoagulable state, and play an important role in preventing DVT formation of lower limbs after total hip replacement; (3) activating collaterals and removing stasis Compared with low molecular weight heparin sodium injection alone, the effect is more prominent, which plays an important role in improving blood microcirculation, so it can play a certain role in the prevention of postoperative lower limb DVT. (Guangxi University of traditional Chinese medicine, 2018)
Adverse reactions
1. The toxicity of this product is low. The main adverse reaction is that excessive medication can cause spontaneous bleeding. Therefore, coagulation time should be measured before each injection. If serious bleeding is caused after injection, protamine sulfate can be injected intravenously for first aid.
2. Occasionally, it can cause allergic reaction and thrombocytopenia, which often occurs in the first 5-9 days of treatment, so the platelet count should be monitored regularly within 1 month after treatment. One time alopecia and diarrhea were occasionally seen. It can also cause osteoporosis and spontaneous fracture. Thrombin III may be used in patients with poor liver function.
Taboo
Patients with heparin allergy, spontaneous bleeding tendency, blood coagulation retardation (such as hemophilia, purpura, thrombocytopenia), ulcers, trauma, postpartum hemorrhage and severe liver dysfunction are prohibited.
matters needing attention
1. Coagulation time should be measured regularly during the medication.
2. Medication for pregnant women and lactating women: medication in late pregnancy and postpartum can increase the risk of maternal bleeding, so it should be used with caution.
3. Medication for children:
(1) Intravenous injection: 50 units / kg was injected once according to body weight, and then 50-100 units were given every 4 hours.
(2) Intravenous drip: 50 units / kg was injected according to body weight, and then 20000 units / m2 per day was given according to body surface area for 24 hours, and then added into sodium chloride injection for slow infusion.
4. Medication for the elderly: the elderly over 60 years old, especially the elderly women, are more sensitive to the drug and are prone to bleeding during the medication. Therefore, the dosage should be reduced and the follow-up should be strengthened.
5. Drug overdose: overdose of this product may cause spontaneous bleeding tendency. When heparin is excessive, 1% protamine sulfate solution can be used to slowly drip, so as to neutralize the effect of heparin. Every 1mg protamine can neutralize 100u heparin sodium.
Drug interactions
1. This product can aggravate the risk of bleeding when combined with the following drugs:
(1) Coumarin and its derivatives can lead to bleeding due to the lack of factor IX.
(2) Aspirin and NSAIDs, including mefenamic acid and salicylic acid, can inhibit platelet function and induce gastrointestinal ulcer bleeding.
(3) Dipyridamole and dextran may inhibit platelet function.
(4) Adrenocorticotropic hormone and adrenocorticotropic hormone are easy to induce gastrointestinal ulcer bleeding.
(5) Others are favorable for uric acid, tissue plasminogen activator (t-PA), urokinase and streptokinase.
2. Heparin combined with sodium bicarbonate, sodium lactate and other drugs to correct acidosis can promote the anticoagulant effect of heparin.
3. Heparin and hyaluronidase mixed injection can not only reduce the pain of intramuscular injection, but also promote the absorption of heparin. However, heparin can inhibit the activity of hyaluronidase, so they should be used together temporarily, and should not be placed for a long time after mixing.
4. Heparin can interact with insulin receptor and change the binding and action of insulin. Hypoglycemia induced by heparin has been reported.
5. The following drugs have incompatibility with this product: kanamycin, amikacin, daunorubicin, erythromycin lactobionate, gentamicin sulfate, hydrocortisone sodium succinate, polymyxin B, doxorubicin, tobramycin, vancomycin, cefmendor, cefoperazole, cefotaxime sodium, chloroquine, chlorpromazine, promethazine, narcotic analgesics.
6. Methimazole and propylthiouracil have synergistic effect with this product.
pharmacological action
Because of its strong negative charge physical and chemical characteristics, it can interfere with many aspects of the process of blood coagulation, and has anticoagulant effect both in vivo and in vitro. Its mechanism of action is complex. It can enhance the inhibitory effect of antithrombin (at - ) on activated coagulation factors ,and . The consequences include preventing platelet aggregation and destruction, hindering the formation of coactivator, preventing prothrombin from changing into thrombin, and inhibiting thrombin, thus preventing fibrinogen from becoming fibrin.
Pharmacokinetics
This product is not absorbed by oral administration, but well absorbed by subcutaneous, intramuscular or intravenous injection. However, when 80% heparin combined with plasma albumin, part of it was absorbed by blood cells, and part of it could diffuse into the space of extravascular tissue. Because of its high molecular weight, it cannot pass through the pleura, peritoneum and placenta. This product is mainly metabolized in reticuloendothelial system and excreted by kidney, a small amount of which is excreted in original form. After intravenous injection, the excretion depends on the dosage. When given 100, 400 or 800 U / kg, T1 / 2 was 1 hour, 2.5 hours and 5 hours respectively. In patients with chronic hepatic and renal insufficiency and obesity, metabolic excretion is delayed and accumulation is possible. The onset time of this product is related to the mode of administration. Intravenous injection immediately exerts the maximum anticoagulant effect, but the individual difference is large. The overall duration of subcutaneous injection is significantly prolonged due to the large individual difference in absorption. Plasma heparin concentration was not affected by dialysis.
Storage method
Store in a cool place (no more than 20 ºC).
term of validity
36 months
Executive Standards
Chinese Pharmacopoeia 2010 Edition Volume 2.
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