Presentation
Heparan sulfate is a ubiquitous compound present in all species analyzed whereas chondroitin sulfate was present in 20 species and heparin-like compounds in 12 species of the invertebrates. [ncbi.nlm.nih.gov]
Entire Body System
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Intravenous Administration
Salmon heparin activity was recovered in plasma samples expressed as antifactor Xa activity after intravenous administration. [ncbi.nlm.nih.gov]
The heparin-induced elevation of the plasma FFA was blocked by the intravenous administration of protamine sulfate 5 min prior to the heparin in 4 control subjects; however, the rise in the TfT 4 was not inhibited. [academic.oup.com]
In patients with STEMI, intravenous administration of up to 5000 U of unfractionated heparin was permitted before arrival at the catheterization laboratory. [nejm.org]
Hematological
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Easy Bruising
Call your doctor at once if you have easy bruising or unusual bleeding, such as a nosebleed, black or bloody tarry stools, or any bleeding that will not stop. [uwhealth.org]
Bleeding may be more likely in older adults, especially women over 60 years of age Stop using heparin and call your doctor at once if you have: skin changes where the medicine was injected; fever, chills, runny nose, or watery eyes; easy bruising, unusual [rxlist.com]
Skin
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Alopecia
Musculoskeletal Frequency not reported: Significant bone demineralization, spontaneous bone fracture Postmarketing reports: Osteoporosis[Ref] Dermatologic Frequency not reported: Ecchymoses Postmarketing reports: Cutaneous necrosis, delayed transient alopecia [drugs.com]
[…] severe thrombocytopenia, usually after 5 days of heparin, with thrombo-embolic complications requiring discontinuation of treatment; • localised reactions at the injection site, rarely, necrosis; • allergic reactions, osteoporosis after prolonged use, alopecia [medicalguidelines.msf.org]
Rarely, LMWH therapy can cause alopecia. The extent of hair loss can vary greatly. All cases of LMWH-related alopecia have resolved upon cessation of therapy. LMWH Antidote The antidote for LMWH is Protamine sulphate. [rch.org.au]
Miscellaneous Osteoporosis following long-term administration of high doses of heparin, cutaneous necrosis after systemic administration, suppression of aldosterone synthesis, delayed transient alopecia, priapism and rebound hyperlipemia on discontinuation [rxlist.com]
Bleeding High blood potassium level (hyperkalaemia) Decrease in the number of platelets in the blood (thrombocytopenia) Breakdown of skin cells Thinning of the bones (osteoporosis) with long term use Hair loss (alopecia) may be experienced after prolonged [netdoctor.co.uk]
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Purpura
Skin necrosis manifests as sharply demarcated tender red or purple patches ( purpura ) which develop black centres and may lead to dry gangrene. A net-like or branching, retiform, pattern of purpura may also be seen. [dermnetnz.org]
Hematologic: conditions associated with increased bleeding tendencies such as hemophilia, some purpuras and thrombocytopenia. In patients with a history of heparin-induced thrombocytopenia (HIT), danaparoid and ancrod are considered alternatives. [rxmed.com]
Pancreas 1 1, 2 Not Yet Recruiting Treatment End Stage Renal Disease (ESRD) 1 1, 2 Recruiting Prevention Thoracic Surgery / Thromboprophylaxis 1 1, 2 Recruiting Prevention Urinary Tract Infections, Recurrent 1 1, 2 Recruiting Treatment Henoch-Schoenlein Purpura [drugbank.ca]
hemophilia, some vascular purpuras, thrombocytopenia); menstruation; hepatic disease with impaired hemostasis; severe hypertension; major surgery, especially involving the eye, brain, or spinal cord; continuous tube drainage of the stomach or small [drugs.com]
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Eczema
[…] anaphylactic shock Postmarketing reports: Chills, fever, urticaria, asthma, rhinitis, lacrimation, headache, nausea, vomiting, anaphylactoid reactions, shock, itching, burning[Ref] Local Frequency not reported: Erythematous nodules, infiltrated and sometimes eczema-like [drugs.com]
Se han descrito diversas lesiones cutáneas adversas, entre ellas urticaria, necrosis cutánea, eczema localizado en el punto de inyección o eczema diseminado. [medigraphic.com]
Face, Head & Neck
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Epistaxis
Often the first sign of bleeding may be epistaxis, hematuria or melena. Bleeding may be from any site and can be difficult to detect, i.e., retroperitoneal bleeds. Bleeding may also occur from surgical sites. [rxmed.com]
Minor hemorrhages were those that were confirmed to be overt and to have some clinically important feature, such as epistaxis, ecchymosis, hematoma, or macroscopic hematuria but that did not meet the criteria for major hemorrhage. [doi.org]
Neurologic
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Severe Headache with Sudden Onset
headaches of sudden onset sudden loss of coordination sudden shortness of breath for no apparent reason sudden slurred speech sudden vision changes unusual bleeding or bruising For Healthcare Professionals Applies to heparin: injectable kit, injectable [drugs.com]
Workup
Improved workup for glycosaminoglycan disaccharide analysis using CE with LIF detection. ELECTROPHORESIS 2008, 29 (22), 4538-4548. DOI: 10.1002/elps.200800335. Sabine Wegehingel, Christoph Zehe, Walter Nickel. [doi.org]
Serum
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Potassium Increased
increased, hyperkalemia, metabolic acidosis Postmarketing reports: Rebound hyperlipidemia[Ref] Musculoskeletal Frequency not reported: Significant bone demineralization, spontaneous bone fracture Postmarketing reports: Osteoporosis[Ref] Dermatologic [drugs.com]
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Lipase Increased
[Ref] Cardiovascular Postmarketing reports: Hemorrhage, retroperitoneal hemorrhage[Ref] Hematologic Very common (10% or more): Thrombocytopenia (up to 30%) Frequency not reported: Plasma lipoprotein lipase increased Postmarketing reports: Heparin resistance [drugs.com]
Treatment
LMW heparins are replacing unfractionated heparin for the prevention and treatment of venous thromboembolism and the treatment of non-ST-segment-elevation acute coronary syndromes. [ncbi.nlm.nih.gov]
Treatment of venous thromboembolism Meta-analyses of RCTs which have directly compared once-daily or twice-daily LMW heparin therapy with unfractionated heparin therapy as initial treatment for patients with venous thromboembolism, both in the hospital [mja.com.au]
treatment, product type, and dosing frequency. [doi.org]
Prognosis
Abstract Glioblastoma multiforme (GBM) is the most common and aggressive brain cancer, and despite treatment advances, patient prognosis remains poor. [stemcell.com]
Prognosis and prophylaxis of this life-threatening disorder, which can develop from the use of unfractionated or (less commonly) low-molecular-weight heparin, are also discussed [lsmuni.lt]
Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006;114:774-782 21. Zeymer U, van ’t Hof A, Adgey J, et al. [nejm.org]
Etiology
The wide range of etiologic microbes and the ongoing development of resistance to antimicrobials with specific mechanisms of action make this an appropriate target for applying a nonspecific antimicrobial therapeutic. [ncbi.nlm.nih.gov]
Vasopasm has been reported 6 to 10 days after starting heparin; the etiology is thought to be allergic. Vasospasm often appears in a limb where an artery has recently been catheterized. The affected limb is usually painful, ischemic and cyanotic. [rxmed.com]
AT deficiency can be either congenital or acquired in etiology. [journals.lww.com]
Epidemiology
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]
Emmanuel Spanakis, Human DNA Sampling and Banking, Molecular Genetic Epidemiology — A Laboratory Perspective, 10.1007/978-3-642-56207-5_2, (27-53), (2002). [doi.org]
[citation needed] Epidemiology[edit] Up to 8% of patients receiving heparin are at risk to develop HIT antibodies, but only 1–5% on heparin will progress to develop HIT with thrombocytopenia and subsequently one third of them may suffer from arterial [en.wikipedia.org]
Hylek, MD, MPH, General Medicine Division/Clinical Epidemiology Unit, Ninth Floor, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114. Accepted for publication June 19, 2002. [jamanetwork.com]
Epidemiology and mortality of venous thromboembolism across patient populations: a systematic literature review. Value in Health. 2013;16:A1-A298. [ Links ] 5. Guijarro Merino R, Montes Santiago J, San Román Terán CM. [scielo.isciii.es]
Pathophysiology
The exact pathophysiology is not well understood. Hemorrhagic bullous dermatosis is a rare cutaneous reaction that is temporally associated with the initiation of heparin products. [ncbi.nlm.nih.gov]
Held PG (1990) Pathophysiology of cardiopulmonary bypass. In: Hemsley FA, Martin DE (eds) The practice of cardiac anesthesia. Little, Brown, Boston Google Scholar 13. [link.springer.com]
Although the clinical significance of ACE lesions was initially a source of debate and discussion, it is clear that their pathophysiology is ischemic injury (6). [electrophysiology.onlinejacc.org]
Glycosaminoglycans (GAGs), located on animal cell membranes and in the extracellular matrix, are important molecules in cellular communication during development, in normal physiology and pathophysiology. [doi.org]
Prevention
Pregnancy LMW heparins are being used increasingly in pregnant women with prosthetic heart valves and for the prevention and treatment of venous thromboembolism. [mja.com.au]
Treatment of venous thrombosis should not be oriented in the prevention of thrombus progression and associated thromboembolic events, but also in stimulation of thrombolysis and recanalization of occluded veins, which are one of the most important preventive [ncbi.nlm.nih.gov]
Prevention of venous thrombosis and pulmonary embolism. Am J Cardiol. 1990; 65:50-4C. 197. May GS, Eberlein KA, Furberg CD et al. Secondary prevention after myocardial infarction: a review of long-term trials. [drugs.com]