heparin calcium: clinical use

Prescribing considerations

• Assess bleeding risk, recent trauma or surgery, planned invasive or neuraxial procedures, previous heparin exposure and concurrent medicines affecting haemostasis.
• Older people and those with significant renal or hepatic disease may have greater bleeding risk.
• Consider heparin resistance when the expected anticoagulant response is not achieved.
• Avoid sharing an intravenous line with incompatible preparations unless appropriate flushing and compatibility procedures are followed.

Contraindications and cautions

• Hypersensitivity to heparin or an excipient.
• Active bleeding, haemophilia or another major bleeding disorder.
• Current or previous thrombocytopenia associated with heparin, or prior heparin-related skin necrosis.
• Severe liver disease with bleeding risk, severe hypertension, purpura or increased capillary fragility.
• Major trauma, recent surgery or procedures with a high bleeding risk, including specified brain, spinal and eye procedures.
• Lumbar puncture or regional anaesthetic block in the product-specific circumstances described in the product information.
• Threatened abortion and epidural anaesthesia during birth.
• Concurrent intravenous diclofenac.

Monitoring

• Monitor for bleeding, thrombosis, injection-site necrosis and hypersensitivity.
• Use coagulation testing appropriate to the indication and treatment intensity.
• Monitor platelet counts and investigate new thrombocytopenia or thrombosis, including after treatment ends.
• Check potassium in at-risk patients and during extended treatment.
• Consider haemoglobin, renal and hepatic function according to clinical circumstances.

Clinical pharmacology

Unfractionated heparin inhibits thrombin and potentiates physiological inhibition of factor Xa. It is not absorbed orally, binds extensively to plasma proteins, is metabolised mainly in the liver and has a variable, exposure-dependent half-life.

Formulation and product differences

• The product is a preservative-free solution for injection or concentrate for infusion.
• It may be administered subcutaneously or intravenously, but not intramuscularly.
• The ampoule is for immediate use after opening; unused solution should be discarded.
• The solution should be colourless or straw-coloured and free from turbidity or deposits.