Heparin

Question 1

Heparin MOA

Answer 1

Binds to ATIII which binds to thrombin, inactivating it
Blocks thrombin and factor Xa

Question 2

Heparin Indications

Answer 2

Anticoagulant
Afib with embolization

Question 3

Heparin Contraindications

Answer 3

Severe thrombocytopenia
Uncontrollably bleeding states

Question 4

Heparin Adverse Effects

Answer 4

Hemorrhage
Thrombocytopenia
Heparin resistance/ATIII deficiency with prolonged heparin therapy

Question 5

Heparin Drug Class

Answer 5

Anticoagulant

Question 6

Heparin and Coagulation Testing

Answer 6

ACT
aPTT
Factor Xa

Question 7

Heparin Induced Thrombocytopenia - Types

Answer 7

Type I: non-immune mediated response (as early as one day after exposure)
Type II: immune mediated response (5-14 days after exposure)

Question 8

Heparin Induced Thrombocytopenia Pathophysiology

Answer 8

Causes a hypercoagulable state
PF4 binds to heparin, triggers formation of IgG antibodies, if IgG binds to the FC receptor on a platelet while bound to hep/PF4 complex = HIT

Question 9

Heparin Types

Answer 9

Unfractionated
Low molecular weight

Question 10

Heparin Induced Thrombocytopenia Treatment

Answer 10

Heparin discontinuation
Alternative anticoagulant
Laboratory tests sent
Contraindication: Platelets in acute period

Question 11

Heparin Dosing

Answer 11

300-400U/kg on bypass for target ACT 400-480+
200u/kg off pump for target ACT 300+
ECMO: 50-100 units/kg loading dose for target ACT 180-250
7.5 to 20 units/kg/hr infusion rate

Question 12

Heparin Reversal

Answer 12

1 mg protamine sulfate: 100 units heparin
Often max protamine dose recommended 250 mg

Question 13

Heparin Resistance

Answer 13

More than 2* the calculated loading dose to achieve 400 minimum ACT
Administer ATIII or FFP