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Does heparin cause side effects?
Heparin prevents blood clots by blocking the action of 4 of the 12 clot-promoting proteins in blood (factors II, VII, IX, X) whose action is necessary for blood to clot. Brand names available for heparin include Hemochron, Hep-Lock, Hep-Lock U/P, Heparin in 5% Dextrose, Heparin Lock Flush, HepFlush-10.
Common side effects of heparin include
- low platelet count (thrombocytopenia),
- heparin induced thrombocytopenia (HIT),
- heparin induced thrombocytopenia and thrombosis (HITT),
- injection site discomfort/irritation,
- allergy or hypersensitivity type reactions, and
- increased liver enzymes.
Serious side effects of heparin include severe bleeding.
Drug interactions of heparin include medications that increase the risk of bleeding such as aspirin, clopidogrel, warfarin, other anticoagulants, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, and others, because these add to the effects of heparin and further increase the risk of bleeding that is associated with heparin.
Heparin has not been adequately evaluated in pregnant women. Heparin should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Preservative-free heparin is recommended when heparin is needed during pregnancy.
It is unknown if heparin is excreted into breast milk. Due to its large molecular weight, it is thought heparin is not likely to be excreted into breast milk. Preservative-free heparin is recommended when heparin is needed during breastfeeding.
What are the important side effects of heparin?
The most common side effects are hemorrhage (bleeding), thrombocytopenia (decrease platelet count), heparin induced thrombocytopenia (HIT), heparin induced thrombocytopenia and thrombosis (HITT), injection site discomfort/irritation, allergy or hypersensitivity type reactions, and increase in liver enzymes.
Heparin side effects list for healthcare professionals
Hemorrhage is the chief complication that may result from heparin therapy. An overly prolonged clotting time or minor bleeding during therapy can usually be controlled by withdrawing the drug. It should be appreciated that gastrointestinal or urinary tract bleeding during anticoagulant therapy may indicate the presence of an underlying occult lesion. Bleeding can occur at any site but certain specific hemorrhagic complications may be difficult to detect:
- Adrenal hemorrhage, with resultant acute adrenal insufficiency, has occurred during anticoagulant therapy. Therefore, such treatment should be discontinued in patients who develop signs and symptoms of acute adrenal hemorrhage and insufficiency. Initiation of corrective therapy should not depend on laboratory confirmation of the diagnosis since any delay in an acute situation may result in the patient's death.
- Ovarian (corpus luteum) hemorrhage developed in a number of women of reproductive age receiving short- or long-term anticoagulant therapy. This complication if unrecognized may be fatal.
- Retroperitoneal hemorrhage.
Generalized hypersensitivity reactions have been reported with chills, fever, and urticaria as the most usual manifestations, and asthma, rhinitis, lacrimation, headache, nausea and vomiting and anaphylactoid reactions, including shock, occurring more rarely. Itching and burning, especially on the plantar site of the feet may occur.
Thrombocytopenia has been reported to occur in patients receiving heparin with a reported incidence of 0 to 30%. While often mild and of no obvious clinical significance, such thrombocytopenia can be accompanied by severe thromboembolic complications such as
- skin necrosis,
- gangrene of the extremities that may lead to amputation, myocardial infarction, pulmonary embolism, stroke and possibly death.
Certain episodes of painful, ischemic and cyanosed limbs have in the past been attributed to allergic vasospastic reactions. Whether these are in fact identical to the thrombocytopenia associated complications remains to be determined.
- 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 of heparin sodium have also been reported.
- Significant elevations of aminotransferase (SGOT [S-AST] and SGPT [S-ALT]) levels have occurred in a high percentage of patients (and healthy subjects) who have received heparin.
What drugs interact with heparin?
- Heparin sodium may prolong the one-stage prothrombin time. Therefore, when heparin sodium is given with dicumarol or warfarin sodium, a period of at least 5 hours after the last intravenous dose should elapse before blood is drawn if a valid Prothrombin time is to be obtained.
- Drugs such as acetylsalicylic acid, dextran, phenylbutazone, ibuprofen, indomethacin, dipyridamole, hydroxychloroquine and others that interfere with platelet aggregation reactions (the main hemostatic defense of heparinized patients) may induce bleeding and should be used with caution in patients receiving heparin sodium.
- Digitalis, tetracyclines, nicotine, antihistamines or I.V. nitroglycerin may partially counteract the anticoagulant action of heparin sodium.
Drug/Laboratory Test Interactions
- Significant elevations of aminotransferase (SGOT [S-AST] and SGPT [SALT]) levels have occurred in a high percentage of patients (and healthy subjects) who have received heparin.
- Since aminotransferase determinations are important in the differential diagnosis of myocardial infarction, liver disease, and pulmonary emboli, rises that might be caused by drugs (like heparin) should be interpreted with caution.
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Related Disease Conditions
Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
Deep vein thrombosis (DVT) is a blood clot in the deep veins, and can be caused by broken bones, trauma to a limb, immobility, medications, smoking, cancer, genetic predisposition, and cancer. Symptoms of a deep vein thrombosis in a leg are swelling, tenderness, redness, warmth, and pain. Treatments for DVT include medications and surgery.
Blood Clots (in the Leg)
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for causes of blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Pulmonary Embolism (Blood Clot in the Lung)
A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
How Serious Is a Blood Clot in the Lungs?
A blood clot is a solid or semisolid clump of blood. When the tissues of our body are injured, excessive blood loss is prevented by the clotting of blood. When a blood clot occurs inside the blood vessels it may lead to serious medical conditions. When a blood clot occurs inside the arteries to the lungs, the condition is called pulmonary embolism (PE).
What Does a Blood Clot Feel Like?
Blood clots are semi-solid masses of blood that may be immobile (thrombosis) and impede blood flow or dislodge to other parts of the body (embolism). Deep vein clots, if dislodged, can travel through veins through the lungs to the arteries in the lungs. This is referred to as a pulmonary embolism and can be deadly. Blood clots can also lead to a heart attack or stroke.
How Do You Know If You Have a Blood Clot in Your Leg?
Blood clots are clumps of blood formed when the blood changes from a fluid to a semisolid form. When a blood clot is formed in one of the large veins in the legs or arms, the condition is called deep vein thrombosis (DVT). A blot clot in your leg can hamper the flow of oxygen and nutrients to the affected area. An untreated DVT may cause the clot to grow bigger and break in small pieces that can travel to other organs, such as the heart and lungs, causing serious consequences.
Treatment & Diagnosis
Medications & Supplements
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.