Heparin (IV/SC)

Unfractionated Heparin·Haematology - Anticoagulants & Haemostatics

Treatment of VTE/PE, ACS, cardiopulmonary bypass, dialysis lines, VTE prophylaxis in severe renal failure

HEPARINHeparin Sodium (Various brands)Ampoules for SC injection (eS4TGA

Max Dose

Titrated to aPTT

Half-life

1-2 h

HIT Risk

CRITICAL

Reversal

PROTAMINE (100%)

Rapid Summary

Overview

Unfractionated Heparin (UFH). A highly volatile, fast-acting anticoagulant. Requires continuous IV infusion and strict blood monitoring, but uniquely safe in end-stage renal failure.

Maximum Dose

Titrated dynamically based on nomograms (Targeting specific aPTT levels).

Clinical Focus

Carries the highest risk of Heparin-Induced Thrombocytopenia (HIT). But unlike Enoxaparin, it is 100% reversible in minutes with Protamine.

Bottom Line

Heparin (IV/SC) is the standard parenteral anticoagulant for VTE and ACS with rapid onset and short duration, but requires aPTT monitoring and carries the risk of heparin-induced thrombocytopenia (HIT).

Formulation & Access

Brand Names

Heparin Sodium (Various brands)

Parenteral

Ampoules for SC injection (e.g., 5000 U/0.2 mL). Vials/Bags for IV infusion.

Prescribing & PBS

Hospital supply only. S4.

Indications & Use

Primary

TGA

Treatment of VTE/PE, ACS, cardiopulmonary bypass, dialysis lines, VTE prophylaxis in severe renal failure.

Clinical Place

Superseded by Enoxaparin/DOACs for general ward use. Reserved for ICU/Dialysis/Cardiac Surgery where instant 'on/off' control and reversibility is mandatory.

Quick reference

Class & Role

Unfractionated Heparin — Unfractionated Heparin (UFH).

Route / Formulation

Ampoules for SC injection (e.g., 5000 U/0.2 mL). Vials/Bags for IV infusion. (Heparin Sodium (Various brands))

Usual Dose & Max

IV Infusion Initial bolus (e.g., 5000 Units), followed by continuous infusion (e.g., 1000-1500 Units/hr). Titrate strictly to aPTT every 6 hours. Titrated dynamically based on nomograms (Targeting specific aPTT levels).

Key Indication Doses

Therapeutic Anticoagulation (ACS / PE / DVT): IV Infusion Initial bolus (e.g., 5000 Units), followed by continuous infusion (e.g., 1000-1500 Units/hr). Titrate strictly to aPTT every 6 hours. VTE Prophylaxis (Renal Failure): SC 5000 Units BD or TDS (Used specifically when eGFR < 30 and LMWH is contraindicated). Renal Impairment: Excreted by macrophages/endothelium, NOT the kidneys. The absolute anticoagulant of choice in severe AKI/CKD.

Best Uses

Avoid / Cautions

History of HIT, active uncontrollable bleeding, severe thrombocytopenia, planned epidural within 4 hours. Pregnancy Category C. Does not cross the placenta. Safe to use.

Key Risks

Haematological: Haemorrhage. HIGH — Heparin-Induced Thrombocytopenia (HIT). Immune-mediated paradoxical massive clotting and dropping platelets. Metabolic: Hyperkalemia (suppresses aldosterone synthesis). Musculoskeletal: Osteoporosis (with long-term chronic use > 1 month).

Key Interactions

Other anticoagulants, Aspirin, NSAIDs. Massive bleeding risk.

Monitoring

Strict aPTT tracking every 6 hours during IV infusion until stable. Check FBC (platelets) daily or every 2nd day to screen for HIT. Two-nurse check required for all pump adjustments. Heparin errors are notoriously lethal.

Clinical Pearl

If a patient on an IV Heparin infusion suddenly develops a DVT or a black, necrotic toe, and their platelet count drops by 50%, they have HIT. The heparin has caused their immune system to turn the drug into a massive pro-clotting weapon. Stop the heparin instantly and call Hematology.

Access

Heparin Sodium (Various brands)

Brand: Heparin Sodium (Various brands)

Heparin (IV/SC)

Unfractionated Heparin·Haematology - Anticoagulants & Haemostatics

Treatment of VTE/PE, ACS, cardiopulmonary bypass, dialysis lines, VTE prophylaxis in severe renal failure

HEPARINHeparin Sodium (Various brands)Ampoules for SC injection (eS4TGA

Max Dose

Titrated to aPTT

Half-life

1-2 h

HIT Risk

CRITICAL

Reversal

PROTAMINE (100%)

Rapid Summary

Overview

Unfractionated Heparin (UFH). A highly volatile, fast-acting anticoagulant. Requires continuous IV infusion and strict blood monitoring, but uniquely safe in end-stage renal failure.

Maximum Dose

Titrated dynamically based on nomograms (Targeting specific aPTT levels).

Clinical Focus

Carries the highest risk of Heparin-Induced Thrombocytopenia (HIT). But unlike Enoxaparin, it is 100% reversible in minutes with Protamine.

Bottom Line

Formulation & Access

Brand Names

Heparin Sodium (Various brands)

Parenteral

Ampoules for SC injection (e.g., 5000 U/0.2 mL). Vials/Bags for IV infusion.

Prescribing & PBS

Hospital supply only. S4.

Indications & Use

Primary

TGA

Treatment of VTE/PE, ACS, cardiopulmonary bypass, dialysis lines, VTE prophylaxis in severe renal failure.

Clinical Place

Superseded by Enoxaparin/DOACs for general ward use. Reserved for ICU/Dialysis/Cardiac Surgery where instant 'on/off' control and reversibility is mandatory.

Quick reference

Class & Role

Unfractionated Heparin — Unfractionated Heparin (UFH).

Route / Formulation

Ampoules for SC injection (e.g., 5000 U/0.2 mL). Vials/Bags for IV infusion. (Heparin Sodium (Various brands))

Usual Dose & Max

Key Indication Doses

Best Uses

Avoid / Cautions

History of HIT, active uncontrollable bleeding, severe thrombocytopenia, planned epidural within 4 hours. Pregnancy Category C. Does not cross the placenta. Safe to use.

Key Risks

Key Interactions

Other anticoagulants, Aspirin, NSAIDs. Massive bleeding risk.

Monitoring

Clinical Pearl

Access

Heparin Sodium (Various brands)

Brand: Heparin Sodium (Various brands)