Heparin Flush (heparin sodium,porcine in 0.9 % sodium chloride)
Intravenous Syringe (ML)
Last reviewed · Source: First Databank (FDB) drug data
Overview
USES: This medication is used to keep IV catheters open and flowing freely. Heparin helps to keep blood flowing smoothly and from clotting in the catheter by making a certain natural substance in your body (anti-clotting protein) work better. It is known as an anticoagulant.
This form of heparin must not be used to treat or prevent blood clots in the body. Some products should not be used for newborns due to an increased risk of side effects. Check with your doctor or pharmacist for more details.
Generic name: heparin sodium,porcine in 0.9 % sodium chloride
Pronunciation: (HEP-a-rin)
Therapeutic class: Hematological Agents
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Heparin Flush
Indications
The following indications are listed for Heparin Flush:
- Maintain Patency Of Indwelling Intravenous Catheter
Also known as: Prevent Clot Occlusion Of Intravenous Catheter.
Dosing
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Drug interactions
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Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
Anticoagulant;Antiplatelet;Thrombolytic/Alipogene Tiparvovec
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Alipogene tiparvovec is given as a one-time series of intramuscular (IM)injections. Depending upon patient weight 27 to 60 injections are given, each at a different site.
CLINICAL EFFECTS: Concurrent use of anticoagulant, antiplatelet, or thrombolytic agents increase bleeding risk at IM injection sites.
PREDISPOSING FACTORS: The risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs).
PATIENT MANAGEMENT: Antiplatelet or other anticoagulant agents must not be taken for at least one week prior to alipogene tiparvovec therapy. Assure that abnormal bleeding parameters have been corrected prior to administration. Antiplatelet or anticoagulant therapy may be resumed one day after alipogene tiparvovec administration. If concurrent therapy is deemed medically necessary, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory tests (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug.
DISCUSSION: Alipogene tiparvovec is given as a one-time series of intramuscular (IM)injections for the treatment of familial lipoprotein lipase deficiency. Depending upon patient weight 27 to 60 injections are given, each at a different site. Concurrent use of anticoagulant, antiplatelet, or thrombolytic agents increase bleeding risk at IM injection sites.
Heparin/Coagulation Factor Xa, Inactivated (ANDEXANET)
SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.
MECHANISM OF ACTION: Inactivated coagulation factor Xa may bind to the heparin-antithrombin III (ATIII) complex, resulting in heparin unresponsiveness.(1)
CLINICAL EFFECTS: Inactivated coagulation factor Xa may inhibit the anticoagulant effect of heparin. The extent and duration of this interaction is unknown.(1,2)
PREDISPOSING FACTORS: None determined.
PATIENT MANAGEMENT: Avoid the use of inactivated coagulation factor Xa prior to heparinization.(1,2) If anticoagulation is anticipated before the inactivated coagulation factor Xa has been given, consider the use of 4-factor prothrombin complex concentration for factor X inhibitor reversal.(3) If anticoagulation is needed after inactivated coagulation factor Xa has been given, consider an alternative anticoagulant to heparin, like argatroban or bivalirudin.(3)
DISCUSSION: A 70-year-old man on rivaroxaban for atrial fibrillation presented with a ruptured abdominal aortic aneurysm (AAA). He was given inactivated coagulation factor Xa to reverse anticoagulation and taken to surgery for AAA repair. During the procedure, he received a total of 14,000 units of unfractionated heparin (UFH) without a change in his activated clotting time (ACT). The patient developed an iliac artery thrombus thought to be a result of the failure to achieve therapeutic anticoagulation during the procedure.(3,4) A 72-year-old man on apixaban for atrial fibrillation underwent an elective radiofrequency ablation procedure complicated by cardiac tamponade. Inactivated coagulation factor Xa was started to reverse anticoagulation. Subsequently, a left ventricular free wall rupture was discovered, and the patient was placed under cardiopulmonary bypass (CPB) for repair. Despite administration of 80,000 units of UFH, the patient's ACT was minimally increased and thrombi formed in the operating field and CPB circuit. Inactivated coagulation factor Xa was stopped and antithrombin III 1,000 units was given, leading to an out of range ACT (>999 seconds). ACT subsequently normalized after administration of protamine sulphate.(5)
There are no severe interactions for this drug.
Moderate Interaction: Assess the risk to the patient and take action as needed.
Anticoagulants/Lifileucel
SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.
MECHANISM OF ACTION: Internal organ hemorrhage, including intraabdominal and intracranial hemorrhage, has been reported in the presence of persistent or repeated thrombocytopenia following treatment with lifileucel.(1)
CLINICAL EFFECTS: Concurrent use or recent therapy with lifileucel and an anticoagulant may increase the risk of life-threatening hemorrhage, including intraabdominal and intracranial hemorrhage.(1)
PREDISPOSING FACTORS: The risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia).
PATIENT MANAGEMENT: The US manufacturer states patients with persistent or repeated thrombocytopenia after receiving lifileucel should not use anticoagulants. If anticoagulation therapy is warranted, close monitoring of patients must take place.(1) The US manufacturer recommends withholding or discontinuing lifileucel if internal organ hemorrhage is indicated, or patient is ineligible for IL-2 (aldesleukin) infusion.(1) If concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory tests (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling.
DISCUSSION: In the open-label single-arm study of 156 adult patients, two cases of internal organ hemorrhage (abdominal hemorrhage and intracranial hemorrhage) leading to death were reported.(1) The incidence of grade 3 or 4 laboratory abnormalities occurring in melanoma patients following treatment with lifileucel included thrombocytopenia (78.2%), neutropenia (69.2%) and anemia (58.3%). Prolonged thrombocytopenia occurred in 30.1% of patients.(1)
Contraindications
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- Aortic aneurysm with dissection
- Cerebral amyloid angiopathy
- Heparin-induced thrombocytopenia
- Intracerebral hemorrhage
- Subarachnoid intracranial hemorrhage
- Subdural intracranial hemorrhage
- Threatened abortion
- Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min
- Chronic kidney disease stage 5 (failure) GFr<15 ml/min
- Deep peripheral nerve block
- Deep plexus block
- Diverticulitis of gastrointestinal tract
- Gastrointestinal ulcer
- Hemophilia
- Hemorrhage
- Invasive procedure on brain
- Invasive procedure on spine
- Neuraxial anesthesia
- Placement of indwelling epidural catheter
- Severe uncontrolled hypertension
- Subacute infective endocarditis
- Surgical procedure on eye proper
- Thrombocytopenic disorder
- Ulcerative colitis
- Antithrombin III deficiency
- Hemorrhage
- Hyperkalemia
- Indwelling vascular catheter
- Kidney disease with likely reduction in glomerular filtration rate (GFr)
- Osteoporosis
- Severe hepatic disease
Adverse reactions
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More Frequent
- Hemorrhage
- Heparin-induced thrombocytopenia
- Thrombocytopenic disorder
Rare or Very Rare
- Anaphylaxis
- Hypersensitivity drug reaction
- Paresthesia of plantar surface
- Thrombosis in heparin-induced thrombocytopenia
- Urticaria
Rare or Very Rare
- Asthma
- Chills
- Eye tearing
- Fever
- Headache disorder
- Nausea and vomiting
- Peripheral neuropathy
- Pruritus of skin
- Rhinitis
Precautions
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ICD codes
| Code | Type | Description |
|---|---|---|
| Maintain patency of indwelling intravenous catheter | ||
| Z45.2 | ICD10CM | Encounter for adjustment and management of vascular access device |
ICD code information from First Databank (FDB).
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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