Heparin
What is it? - It’s an anticoagulant medication that stops the clotting of the blood and formation of fibrin clots. Types of heparin: - Unfractioned heparin (IV heparin) - Low molecular weight heparin (Sub-cut heparin e.g. enoxaparin, daltaparin, tinzaparin) When is it used? - Post general surgery (Sub cut heparin). - All ICU patients (Sub cut heparin). - Post cardiac surgery patients (IV heparin infusion). - In the CVVH (Continuous Veno-Venous Hemofiltration) machine to keep the circuit patent. What are the Contraindications? - Severe thrombocytopenia (Low blood platelet levels). - Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). - Major haemorrhage. What is HITTS? - It is the development of Thrombocytopenia (Low platelets) due to the administration of heparin that then causes thrombosis (The abnormal formation of clots in the blood). - This may be a venous clot in the arm/ leg (Deep Vein Thrombosis aka DVT), a clot in the lung (Pulmonary Embolism aka PE), a clot in the arteries of the heart muscle (Myocardial Infarction aka MI) or a clot in the arteries to the brain causing a stroke. - If a patient is diagnosed with HITTS, the heparin is stopped and then an alternate IV blood thinner medication like Argatroban or Danaparoid should be given. Monitoring requirements: - Patients on a LWMH don’t usually require any blood test monitoring unless requested. - Patients on an IV heparin infusion require 2-4hr aPTT & INR monitoring and adjustment of the rate of infusion/ bolus of heparin depending on the results (Refer to trust policy). - Patients who have IV heparin infused via the CVVH machine require 6hr aPTT & INR monitoring and adjustment of the rate of infusion depending on the results (Refer to trust policy). What are anti factor Xa levels? - It’s a blood test to determine the effectiveness of therapeutic LWMH dose, although it is not commonly used apart from in COVID ICU. - You will be asked take a serum factor Xa blood test 3-5 hours after a dose of LWMH. By: https://www.instagram.com/p/CaE3mXvNmK0/?utm_source=ig_web_copy_link