Page 131 - 2026 SMOG

HEPARIN
Class/Mechanism of Action
• Anticoagulant
Inactivates thrombin and activated coagulation factors (IX, X, XI, XII, and plasmin) and prevents
conversion of fibrinogen to fibrin.
Indications
• Labeled Indications
Treatment of thromboembolic disorders
• ˚ Off-Label Indications
˚ ST elevation MI (STEMI) as an adjunct to thrombolysis; unstable angina/non-STEMI
Contraindications
• Hypersensitivity to heparin or any component of the formulation (unless a life-threatening situation
necessitates use and an alternative anticoagulant is not available)
• Uncontrolled active bleeding (except when caused by disseminated intravascular coagulation)
• Severe thrombocytopenia (low platelet level); history of heparin-induced thrombocytopenia
• Not for use when appropriate blood coagulation tests cannot be obtained at appropriate intervals
Adverse Reactions/Precautions
• Continuously monitor for bleeding; Stop immediately if any bleeding occurs
• Urticarial reactions and anaphylaxis can occur
• Heparin-induced thrombocytopenia (HIT) may occur during heparin therapy. Discontinue therapy as HIT
can be fatal without treatment.
• Pregnancy: Safe
• Lactation: Safe, use preservative-free formulation
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Acute Coronary Syndromes: STEMI/Unstable Treatment of Venous Thromboembolism
Angina as an Adjunct to Fibrinolysis (Full Dose (Off-Label)
Alteplase) • IV
• IV Infants: Initial loading dose: 75units/kg over
Initial: 60units/kg bolus (max: 4000 units) ˚ 10min; then initial continuous maintenance
˚ Continuous maintenance infusion: infusion at 28units/kg/hr
˚ 12units/kg/hr (max: 1000 units/hr) Children and Adolescents: Initial loading
Arterial Occlusion ˚ dose: 75units/kg over 10min, then initial
• IV continuous maintenance infusion at
60–80units/kg; followed by continuous 20units/kg/hr
˚ 12–18units/kg/hr. Adjust the infusion rate to
maintain the coagulation rate
Treatment of Venous Thromboembolism
(Off-Label)
• SubQ
5000 units q8hr
˚ Should be considered prior to aeromedical
˚ evacuation for KNOWN VTE
COVID VTE Prophylaxis
• SubQ
˚ 7500 units q8hr
Note: Heparin is ONLY for use under the written
direction of the referring provider or direct
consultation with the medical director
2026 Standard Medical Operating Guidelines (SMOG) • 123