Bluehep Special Precautions

When considered for use in any of the following conditions, the advantages of heparin therapy must be carefully weighed against the risks: subacute bacterial endocarditis; increased capillary permeability; dissecting aneurysm; severe hypertension; during and immediately following major surgery, especially of the brain, spinal cord, eye or ear; conditions associated with increased bleeding tendencies such as hemophilia, thrombocytopenia and some purpuras; inaccessible gastrointestinal ulcers; ulcerative colitis; continuous tube drainage of stomach or small intestine; threatened abortion; menstruation; malignant hypertension. Heparin Sodium Injection should be used with caution in the immediate postoperative period. Bleeding may be concealed, as in the case of hemothorax. In patients with a history of heparin-induced thrombocytopenia (HIT), heparinoids (e.g., danaparoid), lepirudin and ancrod are considered appropriate alternatives to heparin. When used in therapeutic doses, heparin should be regulated by frequent blood coagulation indicators, particularly the APTT. If the indicator is unduly prolonged or if hemorrhage occurs, heparin should be at least temporarily discontinued.
Heparin can prolong the prothrombin time. Apparent resistance to heparin may be encountered in patients with acquired or familial AT III deficiency, because adequate levels of AT III are required for heparin's anticoagulant effect. Larger doses of heparin may be required initially in patients with various disease states due to alterations in their physiology, the pharmacokinetics of the drug, or elevations in levels of acute phase heparin binding proteins. Among these are febrile illness, infections associated with thrombosing tendencies, pulmonary embolism, myocardial infarction, extensive thrombotic disorders especially those associated with neoplastic disease and following surgery. Heparin should be used with caution in the presence of severe hepatic or renal disease, or in patients with indwelling catheters. A higher incidence of bleeding may be seen in women over 60 years of age. IM injections of other drugs should be avoided during heparin therapy to reduce the risk of hematoma formation and bleeding from the site. Most drugs can be given by another route (I.V. or S.C.). For these reasons, strict laboratory control of dosage is necessary. Heparin Sodium Injection should be used with caution in patients with allergy. Patients on long-term daily administration of Heparin Sodium Injection should be observed for the possible development of osteoporosis and spontaneous fractures of ribs and/or vertebrae.