헤파린 나트륨
Heparin Sodium
Unfractionated Heparin (UFH)
다른 이름: Hep-Lock · Hep-Loc U/P · Hepflush-10 · Unfractionated Heparin · UHF · heparinum natricum · sodium heparin · soluble heparin
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
구조화 용량 계산 근거Thromboprophylaxis (extra-label)
인증된 수의사 확인 필요
- q6h
NA
반드시 함께 고려할 임상 맥락 (2)
- Heparin is an anionic, heterogeneous sulfated glycosaminoglycan molecule with an average molecular weight of 12,000 daltons that is found naturally in mast cells. It is available commercially as the sodium salt and is obtained from either porcine intestinal mucosa or bovine lung tissue (sodium salt only). Heparin sodium occurs as a white, amorphous, hygroscopic powder having a faint odor. It is soluble in water and practically insoluble in alcohol; the commercial injections have a pH of 5 to 7.5. Heparin potency is expressed in terms of USP heparin units, and values are obtained by comparing against a standard reference from the USP. The USP requires that potencies be not less than 180 units/mg on a dried basis for heparin derived from lung tissue, and 140 units/mg when derived from all other tissue sources.
- Heparin solutions should be stored at room temperature (15°C-30°C [59°F-86°F]) and not frozen. Avoid excessive exposure to heat.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
헤파린 나트륨은 수의학에서 주로 혈전색전증 관리 및 논란의 여지가 있는 파종성 혈관내 응고(DIC) 치료에 사용되는 주사용 항응고제입니다.
주요 임상 적용:
- 혈전 예방: 고위험 환자에서 대혈관 혈전색전증 발생을 줄이는 데 강력한 근거가 있습니다.
- DIC 관리: 역사적으로 DIC에 사용되었으나, 현재의 합의는 동반된 염증 과정이 있는 DIC 환자에게는 사용하지 않을 것을 권장합니다.
- 말 의학: 제엽염 예방, DIC 치료 및 수술 후 장 유착을 예방하기 위한 복강 세척에 사용됩니다.
임상 요점: 미분획 헤파린(UFH)은 저분자량 헤파린(LMWH)에 비해 약동학적 프로파일의 변동성이 매우 큽니다. 치료 효과를 보장하고 치명적인 출혈을 피하기 위해 aPTT 또는 항 Xa 인자 활성에 대한 집중적인 모니터링이 필요합니다.
작용 기전
Heparin acts as an indirect anticoagulant by binding to and potentiating the activity of Antithrombin III (ATIII).
- Low Concentrations: The Heparin-ATIII complex rapidly inactivates Factor Xa, preventing the conversion of prothrombin to thrombin.
- High Concentrations: The complex inactivates Thrombin (Factor IIa), blocking the conversion of fibrinogen to fibrin, and also inactivates factors IX, XI, and XII.
- Fibrin Stabilization: By inhibiting the activation of Factor XIII, heparin prevents the formation of stable fibrin clots.
Note: Heparin does not lyse existing clots (it is not a thrombolytic); rather, it prevents the expansion of existing thrombi and the formation of new ones. It also increases the release of lipoprotein lipase, boosting the clearance of circulating lipids.
안전성·주의사항
금기사항
- Known hypersensitivity to heparin
- Severe thrombocytopenia
- Uncontrollable bleeding (not caused by DIC)
- Intramuscular (IM) administration (causes hematomas)
- Actively bleeding DIC patients with severe factor depletion
부작용
- Hemorrhage (most common)
- Thrombocytopenia
- Hypersensitivity reactions (derived from bovine/porcine tissue)
- Anemia in horses (due to erythrocyte agglutination)
- Injection site pain and hematoma (especially if given IM)
- Vasospastic reactions
- Osteoporosis (with long-term use)
- Rebound hyperlipidemia
- Hyperkalemia
- Alopecia
주의
Use with extreme caution in patients with dysfunctional interactions between inflammatory and hemostatic systems (e.g., DIC with concurrent inflammation). Do not administer IM due to the risk of severe hematoma formation. Deep SC dosing may cause pain and irritation. Dogs with renal insufficiency may have lower plasma levels and faster elimination rates, requiring dosage adjustments. Safe use in pregnancy is not firmly established (FDA Category C).
약물 상호작용
May increase the risk for hemorrhage
May increase the risk for hemorrhage
May increase the risk for hemorrhage
May increase the risk for hemorrhage
May partially counteract heparin's anticoagulant effects
May partially counteract heparin's anticoagulant effects
May partially counteract heparin's anticoagulant effects
May partially counteract heparin's anticoagulant effects
May partially counteract heparin's anticoagulant effects
모니터링
- Activated partial thromboplastin time (aPTT) - most often recommended
- Whole blood clotting time (WBCT)
- Partial thromboplastin time (PTT)
- Activated clotting time (ACT)
- Thromboelastography (TEG)
- Platelet counts
- Packed cell volume (PCV) / Hematocrit
- Occult blood in stool and urine
- Clinical signs of bleeding or efficacy
약동학
흡수
Not absorbed orally; must be given parenterally. Anticoagulant activity begins immediately after direct IV bolus, but may take up to 1 hour after deep SC injection. Bioavailability after SC injection in healthy dogs is about 50%.
분포
Extensively protein bound, primarily to fibrinogen, low-density lipoproteins, and globulins. Does not appreciably cross the placenta or enter milk.
대사
Metabolic fate is not completely understood. Partially metabolized by the liver and inactivated by the reticuloendothelial system.
배설
Eliminated via hepatic metabolism and the reticuloendothelial system. Dogs with renal insufficiency may have faster elimination rates.
과다투여
Overdosage of heparin is directly associated with severe bleeding.
Clinical signs preceding frank hemorrhage include:
- Hematuria
- Tarry stools (melena)
- Petechiae and ecchymoses (bruising)
Reversal: Protamine sulfate can be administered to reverse heparin's anticoagulant effects. It binds to heparin to form a stable, inactive complex.
제품
제형
- Injection solutions (1,000 to 40,000 Units/mL)
- Unit-Dose injections
- Heparin Sodium Lock Flush (10 to 100 Units/mL)
- Heparin Sodium in 0.9% or 0.45% Sodium Chloride
인용의약품
- Heparin Sodium Injection: 1000, 2000, 2500, 5000, 10,000, 20,000, & 40,000 Units/mL
- Heparin Unit-Dose Sodium Injection: 1000 to 20,000 Units/dose
- Heparin Sodium and 0.9% or 0.45% Sodium Chloride Injection
- Heparin Sodium Lock Flush (IV use) Injection: 1, 10, and 100 Units/mL
규제 현황
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보관·안정성
Store solutions at room temperature (15-30°C). Do not freeze. Avoid excessive exposure to heat.
보호자 정보
헤파린은 생명을 위협하는 혈전을 치료하거나 예방하는 데 사용되는 강력한 혈액 희석제입니다.
- 입원 치료: 헤파린 사용 시 집중적인 모니터링(응고 시간을 확인하기 위한 빈번한 혈액 검사)이 필요하고 치료하는 질병의 특성이 심각하기 때문에, 이 약물은 거의 전적으로 동물병원의 입원 환경에서 전문가에 의해서만 사용됩니다.
- 출혈 위험: 가장 큰 위험은 출혈입니다. 반려동물이 헤파린과 유사한 약물을 처방받고 퇴원한 경우, 멍, 잇몸 출혈, 혈뇨 또는 혈변, 극심한 무기력증 등의 징후가 있는지 주의 깊게 관찰하고, 발견 시 즉시 수의사에게 연락하십시오.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.