Heparin Unfractionated (Prophylaxis)

Regimen taken verbatim from the SPC (Heparin (Mucous) Injection BP 1,000 IU, section 4.2, Prophylactic Dosage): 'Patients undergoing major elective surgery: 5,000 IU should be given 2 hours pre-operatively and then every 8-12 hours post-operatively for 10-14 days or until the patient is ambulant, whichever is the longer.' Other prophylactic regimens in the same SPC: following myocardial infarction 5,000 IU twice daily for 10 days or until the patient is mobile; other patients 5,000 IU every 8-12 hours. These standard prophylactic regimens do not require routine control. TREATMENT (non-prophylaxis) doses in the same SPC: intravenous 5,000-10,000 IU every 4 hours, or 500 IU/kg bodyweight daily as a continuous infusion in sodium chloride or dextrose injection; subcutaneous initial dose 250 IU/kg bodyweight then every 12 hours - individually adjusted to maintain thrombin clotting time, whole blood clotting time or APTT 1.5 to 2 times control on blood withdrawn 4-6 hours after the first injection or start of infusion. Haemodialysis: initial bolus 1,000-5,000 IU then continuous IV infusion 1,000-2,000 IU per hour adjusted to maintain clotting time greater than 40 minutes. Pregnancy prophylaxis (this formulation contains benzyl alcohol and should be avoided in pregnancy): suggested dosage 5,000 IU every 12 hours in early pregnancy increasing to 10,000 IU every 12 hours in the last trimester, reduced during labour, with plasma heparin kept below 0.4 IU/ml by anti-Xa assay. Elderly: no dosage alteration necessary for prophylaxis. Neuraxial block timing (section 4.4): for prophylactic doses (15,000 IU/day or less) placement or removal of a peridural or spinal catheter should not be allowed until 4-6 hours after the last heparin administration and the subsequent dose not before at least 1 hour post-procedure; for treatment doses (over 15,000 IU/day) 4-6 hours after the last intravenous dose or 8-12 hours after the last subcutaneous dose. Platelet count should be measured before starting and periodically thereafter because of the risk of immune-mediated heparin-induced thrombocytopenia (type II). Children: the SPC gives only treatment guidance ('standard treatment dosages should be given initially', then individually adjusted by coagulation tests) and no paediatric weight-based prophylaxis dose - see paedDose. NOTE: the fetched SPC sections 4.4 and 4.8 were truncated at the source-fetch limit; section 4.5 was not fetched.