Prophylaxis of thrombophlebitis and thromboembolic disorders in patients with risk factors for these disorders.
Composition:
1 ampoule of 0.2 ml contains 5,000 IU sodium heparin.
Action:
Anticoagulant preparation. In small amounts, Heparin in combination with antithrombin III inactivates the active form of plasma factor X (Xa) and inhibits the transformation of prothrombin into thrombin. In larger quantities, heparin inactivates thrombin and prevents the conversion of fibrinogen to fibrin. It prevents the stabilization of fibrin and inhibits the activation of its stabilizing factor. It does not show fibrinolytic activity. Heparin does not change the time of bleeding, but it can prolong the prothrombin time. It does not cross the placenta and into breast milk.
Contraindications:
Hypersensitivity to the components of the preparation, including benzyl alcohol. Haemophilia, uncontrollable bleeding, e.g. peptic ulcer of the stomach and / or duodenum with bleeding. Extensive injuries, recent intracranial haemorrhage, ophthalmic or neurosurgical operations. Bacterial endocarditis. Hypertension with severe course. Thrombocytopenia present or in an interview. Hepatic disease (including esophageal varices). Active tuberculosis. Increase in capillary permeability. Do not use intramuscularly. Do not use in children.
Precautions:
Particularly cautiously used in patients undergoing spinal anesthesia. The risk of epidural hematoma or spinal cord is greater during repetitive lumbar punctures and administration of drugs affecting hemostasis (NSAIDs, Acetylsalicylic acid, indomethacin, anticoagulants); if heparin is necessary, it should be injected 4 hours before the procedure. Use with caution in patients with renal or hepatic insufficiency and hypersensitivity to low molecular weight heparins. In women after 60 years of age, the preparation increases the risk of bleeding complications for a long time. The risk of hyperkalemia increases with the prolonged use of the preparation. If thrombocytopenia develops, the preparation should be discontinued immediately. Due to the content of benzyl alcohol, the preparation may cause anaphylactoid reactions.
Pregnancy and lactation:
The safety of use during pregnancy has not been established; the preparation can only be used if the expected benefit to the mother outweighs the potential risk to the fetus. Because of the risk of bleeding, use caution in the third trimester of pregnancy and immediately after delivery. Heparin does not pass through the placental barrier or breast milk.
Side effects:
Most often: bleeding in patients with organic changes prone to bleeding, impaired hemostasis in the elderly, in the elderly (especially in women) and while taking medicines that inhibit the activity of platelets. Rare: cutaneous and general hypersensitivity reactions (especially in those who have experienced hypersensitivity reactions after using low-molecular-weight heparin). Occasional: anaphylactic shock. The thrombocytopenia may develop between the 6th and 12th day of use and on re-administration; Usually, the number of plaques returns to normal within 48-72 hours after the end of therapy, however, severe cases have been recorded (the so-called white blood clot syndrome with thromboembolic disorders). The preparation may inhibit the secretion of aldosterone, causing hyperkalemia, especially in patients with diabetes mellitus, chronic renal failure, pre-existing metabolic acidosis, elevated potassium levels or taking potassium-sparing drugs. Long-term administration of Heparin, usually in high doses, was associated with the occurrence of osteoporosis, transient baldness (usually after 4-12 weeks of treatment). Very rare: epidural or spinal haemorrhage in patients using the product prophylactically administered anesthetics to the area of the dura mater or subjected to spinal anesthesia. Heparin may cause an increase in liver transaminases.
Dosage:
Deep subcutaneously, alternately in the left or right anterolateral or posterior lateral region of the abdominal wall.Patients before and after surgery5,000 IU 2 h before surgery, then after surgery every 8-12 h for 10-14 days or until the patient starts walking (depending on what happens sooner).Patients after myocardial infarction5,000 IU 2 times a day for 10 days or until the patient starts walking.Other patients5,000 IU every 8-12 hours.Pregnancy and puerperium: in the I and II trimester, administer 5,000 IU. every 12 hours; in the third trimester, 10,000 IU every 12 h. Do not exceed the concentration of 0.4 IU / ml of heparin in plasma, determined by specific anti-Xa antibodies. The dose should be reduced during delivery.
(C)
