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Heparin is an injectable anticoagulant that is used to prevent the formation of blood clots in the vessels. It is a highly-sulfated glycosaminoglycan and the most highly negatively charged biological molecule known to mankind. It is also used to create an anti-clotting surface inside various medical devices such as renal dialysis machines and test tubes. Pharmaceutical-grade heparin is derived from the mucosal tissue of animals that have been slaughtered for meat such as pigs and cattle. Research conducted in 2011 eventually led to the synthetic development of low molecular weight heparins. Heparin is also sometimes used alone or in combination with aspirin to prevent pregnancy loss and other problems in pregnant women who have certain medical conditions and who have experienced these problems in their earlier pregnancies.

Heparin is used to prevent blood clots from forming in people who have certain medical conditions or who are undergoing certain medical procedures that increase the chance that clots will form. Heparin is also used to stop the growth of clots that have already formed in the blood vessels, but it cannot be used to decrease the size of clots that have already formed. Heparin is also used in small amounts to prevent blood clots from forming in catheters (small plastic tubes through which medication can be administered or blood drawn) that are left in veins over a period of time. Heparin is in a class of medications called anticoagulants ('blood thinners'). It works by decreasing the clotting ability of the blood.

Heparin is an anticoagulant commonly used after surgery. It is used to prevent the blood from clotting too easily while the patient is spending more time resting and off of their feet than usual—which is when blood clots are more likely to form. Heparin is also used to treat blood clots when they do form, helping prevent the clot from increasing in size and preventing additional clots from occurring. Surgery is a known risk factor for the formation of clots and increases the risk of blood clots significantly during the early stages of recovery, so it is common for surgery patients to receive routine doses of Heparin while in the hospital. Heparin is considered an important preventative measure during an inpatient stay after a procedure, and is often stopped when the patient is discharged from the hospital. Heparin is often given after surgery, particularly in patients who remain hospitalized for several days after surgery, to prevent blood clots from forming. Patients who are unable to get out of bed in the days following surgery are at greater risk of forming clots, making heparin a commonly used drug in intensive care units. For these patients, heparin is often given every eight to twelve hours around the clock, in an effort to reduce the risk of a life-threatening pulmonary embolism or clot. Kidney function will often determine how often heparin can safely be given to prevent clots.

Heparin sodium is indicated for: Atrial fibrillation with embolization: Treatment of acute and chronic consumption coagulopathies (disseminated intravascular coagulation). Prevention of clotting in arterial and heart surgery. Anticoagulant therapy in prophylaxis and treatment of venous thrombosis and its extension. (In a low-dose regimen) for prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdomino-thoracic surgery or who for other reasons are at risk of developing thromboembolic disease. Prophylaxis and treatment of pulmonary embolism. Prophylaxis and treatment of peripheral arterial embolism.

How Heparin work?

Anticoagulants work by decreasing the clotting ability of the blood, helping to prevent the formation of clots as well as stopping the further expansion of any existing clots. Although heparin does not break down existing blood clots, it does enhance the body's natural mechanism involved in clot lysis. Heparin is used to manage and treat blood clots that may occur in the heart, legs and lungs. The drug is also used to stop the blood from clotting after surgery, during blood transfusion, during kidney dialysis or while blood is being collected in a sample pot. Heparin increases the level of an anti-clotting protein in the blood, which keeps the blood flowing smoothly.

Further details of the conditions for which heparin use:

Heparin comes as a solution (liquid) to be injected intravenously (into a vein) or deeply under the skin and as a dilute (less concentrated) solution to be injected into intravenous catheters. Heparin should not be injected into a muscle. Heparin is sometimes injected one to six times a day and sometimes given as a slow, continuous injection into the vein. When heparin is used to prevent blood clots from forming in intravenous catheters, it is usually used when the catheter is first put in place, and every time that blood is drawn out of the catheter or medication is given through the catheter.

Heparin as decoy for COVID-19 which may neutralize virus

A new study finds the common drug heparin actually decoys coronavirus and can keep it from making you sick. This approach could be used as an early intervention to reduce the infection among people who have tested positive, but aren't yet suffering symptoms. Researchers say heparin can bind to SARS-CoV-2, the virus causing COVID-19. This prevents it from breaking into human cells and spreading. The FDA-approved drug is a blood thinner that usually treats clots in the lungs or legs. Ultimately, we want a vaccine, but there are many ways to combat a virus, and with the right combination of therapies, we can control the disease until a vaccine is found.

Can Heparin save you from Coronavirus?

Researchers say SARS-CoV-2 uses “spike” proteins on the surface of the virus to slice through your cells. The virus grabs on to ACE-2 genes in the body, hijacking cell functions to reproduce the illness. The study finds the virus can be tricked into grabbing other molecules that resemble ACE-2. Once SARS-CoV-2 follows the decoy, it can't free itself from the bond, neutralizing it. Researchers explains heparin not only attracts the virus, but forms even tighter and unbreakable bonds than normal antibodies can. On a scale measuring the ties between two molecules, the study finds heparin binds to SARS-CoV-2 at 73 picomoles. With COVID-19, the study authors suggest heparin can be taken as a nasal spray or inhaled from a nebulizer. They add the drug can then run interference, lowering the odds of developing symptoms. The results from all the varieties of heparin find it's a promising decoy to use against COVID-19 and future illnesses. We don't really have great antivirals, but this is a pathway forward. We need to be in a position where we understand how things like heparin and related compounds can block virus entry.

Heparin as an anticoagulant in covid-19

Previous failures of anticoagulants in critical illness notwithstanding, compelling observations of coagulopathy and high rates of VTE in COVID-19 raise the possibility that heparin may benefit patient outcomes. The utility of heparin as an anticoagulant in COVID-19 was first posited by a retrospective report of patients with COVID-19 from China. Since these initial reports, there has been published another study, that have investigated the effects of therapeutic heparin in COVID-19. In patients requiring invasive mechanical ventilation, anticoagulation was associated with an in-hospital mortality of 29.1% compared with 62.7% for patients who did not receive anticoagulation.

Heparin's classic function as an anticoagulant, through its interaction with antithrombin-III (AT3), may prove beneficial because of the high prevalence of coagulopathy and clinically significant thrombosis in the disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry into both endothelial and epithelial cells is believed to be dependent on its interaction with cell surface heparan sulfate; thus, heparin (or carefully designed synthetic heparin-like drugs) may inhibit this interaction and block viral entry. Last, heparin has known anti-inflammatory effects that may confer benefit in COVID-19. But based on these limited data, clinical treatment guidelines for COVID-19 have not yet recommended the use of therapeutic heparin or other forms of therapeutic anticoagulation.

How should I use heparin?

Heparin is injected under the skin or as an infusion into a vein. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you don't understand all instructions. Prepare an injection only when you are ready to give it. Do not use the medicine if it has changed colors or has particles in it. Call your pharmacist for new medicine. Do not use a prefilled syringe when giving this medicine to a child. The prefilled syringe contains more than a child's dose of heparin. Heparin increases your risk of bleeding, which can be severe or life-threatening. You will need frequent tests to measure your blood-clotting time. The timing of these tests is very important in helping your doctor determine whether it is safe for you to continue using this medicine. If you need surgery, dental work, or a medical procedure, tell the care provider ahead of time that you are using heparin.

Using heparin safely

Heparin is mostly used in hospital. If you are given heparinto inject yourself at home, your healthcare professional will teach you how to prepare and use it. Here are a few tips on how to use heparin safely:

Risks and Benefits

After its introduction into clinical medicine, heparin remains a source of continuing controversy. Although the areas of disagreement have narrowed, there is still no widely accepted consensus on the optimal mode of administration, the proper dose, the most appropriate mode of monitoring, the clinical indications for and the risks of heparin. The reasons for persisting uncertainty are not particu- larly obscure. Studies of the best route of admin- istration have yielded different conclusions. No single trial has established a correlation between dose and efficacy. No method of monitoring hepa- rin has emerged as clearly the most useful. Most important, while virtually all clinicians would agree that heparin reduces the frequency of initial and recurring pulmonary emboli, their abid- ing perception of the hazards of heparin therapy makes them both reluctant to use heparin and willing to ascribe to it complications that might well have occurred even in its absence.

Pros

Cons

Dosage

Heparin sodium is not effective by oral administration and should be given by intermittent intravenous injection, after dilution in 50 or 100 mL of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP, or by intravenous infusion. The dosage of heparin sodium should be adjusted according to the patient's coagulation test results. When heparin is given by continuous intravenous infusion, the coagulation time should be determined approximately every 4 hours in the early stages of treatment. When the drug is administered intermittently by intravenous injection, coagulation tests should be performed before each injection during the early stages of treatment and at appropriate intervals thereafter. Dosage is considered adequate when the activated partial thromboplastin time (APTT) is 1.5 to 2 times normal or when the whole blood clotting time is elevated approximately 2.5 to 3 times the control value.

Side Effects

Hemorrhage is the chief complication that may result from heparin therapy. An overly prolonged clotting time or minor bleeding during therapy can usually be controlled by withdrawing the drug. It should be appreciated that gastrointestinal or urinary tract bleeding during anticoagulant therapy may indicate the presence of an underlying occult lesion. Bleeding can occur at any site but certain specific hemorrhagic complications may be difficult to detect.

Heparin sodium should not be used in patients: With severe thrombocytopenia. In whom suitable blood coagulation tests — e.g., the whole blood clotting time, partial thromboplastin time, etc. — cannot be performed at appropriate intervals (this contraindication refers to full-dose heparin; there is usually no need to monitor coagulation parameters in patients receiving low-dose heparin); With an uncontrollable active bleeding state, except when this is due to disseminated intravascular coagulation. Intravenous solutions with Heparin Sodium Injection are contraindicated in patients who are hypersensitive to heparin.

What to do?

Heparin is usually given into a vein (intravenously), although it can be given by injection just under the skin (subcutaneously). Heparin rapidly reduces the ability of the blood to clot. Initially, daily blood tests that measure activated partial thromboplastin time (a measure of how fast the blood is clotting) are required. However, daily blood tests are not usually required with low-dose, long-term heparin.

Heparin may make you bruise or bleed more easily. In addition, it may take longer than usual for you to stop bleeding after a cut. Report any significant bruising or bleeding to a doctor or emergency services if more appropriate. Tell your dentist and other health professionals that you are receiving heparin before any surgery, no matter how minor, is scheduled. Talk to your pharmacist or doctor before buying any over the counter medications, herbal remedies, or supplements, because some may contain ingredients that interact with heparin. If you intend to become pregnant or breastfeed while you are on heparin; talk to your doctor first. Call your doctor if you are on heparin and experience unexpected bleeding from your nose or if your periods are significantly heavier. Call emergency services if you have unexplained bleeding in your mouth or when you cough; following a bowel motion; or if you injure or cut yourself and can't stop the blood flow. Tell your doctor if you are sensitive to heparin or pork products before heparin is administered.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use heparin only for the indication prescribed. Heparin is a well-studied medication that has a strong record of preventing blood clots and thrombus—both of which can be life-threatening. Side effects, aside from bleeding more easily, are rare but can be significant when they occur. For most patients, the reward of using heparin after surgery is far greater than the potential risks, but any concerns should be addressed with the surgeon or member of the team providing care while in the hospital.

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