헤파린 나트륨

항응고제

헤파린 나트륨은 수의학에서 주로 혈전색전증 관리 및 논란의 여지가 있는 파종성 혈관내 응고(DIC) 치료에 사용되는 주사용 **항응고제**입니다. 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.

동물 종별 용량

Cats

Adjunctive treatment of DIC · 75 Units/kg SC three times daily OR 5-10 Units/kg/hour by continuous IV infusion OR 50-100 Units/kg SC q6h · SC/IV · Variable · Doses extrapolated from general small animal guidelines in monograph.
Feline arterial thromboembolism · 250-300 Units/kg SC q8h · SC/IV · q8h · First dose is administered IV to cats showing signs of shock.
Maintenance therapy for arterial thromboembolic disease · 250-300 Units/kg SC every 8 hours · SC · q8h · Initial in-hospital therapy

Horses

Prevention of complications associated with hypercoagulable states · Initially 150 Units/kg SC. Then 125 Units/kg q12h for 6 doses and then decreased to 100 Units/kg SC every 12 hours. · SC · q12h
Adjunctive treatment of DIC · 80-100 Units/kg IV q4-6h (may be added to fluids and given as a slow drip). Low grade DIC may be treated with 25-40 Units/kg SC 2-3 times a day. · IV/SC · q4-6h or 2-3x daily
Adjunctive therapy in endotoxic shock · 40 Units/kg IV or SC 2-3 times a day · IV/SC · q8-12h · May prevent the development of microthrombi.
Adjunctive therapy in the prevention of laminitis · 25-100 Units/kg subcutaneously 3 times daily · SC · q8h · Higher doses used when a thrombotic event is underway.
Prevention of abdominal adhesions · 30,000-50,000 Units heparin in 10 L of lavage fluid (warm LRS) administered intraperitoneally · Intraperitoneal · At 12, 18, 36, and 48 hours post-surgery · 48 hours · Administered via a 32 french fenestrated trocar catheter.

투여 경로

IVSCIntraperitoneal (lavage)Intrapleural (lavage)

금기

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

이상반응

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

약물 상호작용

Aspirin · May increase the risk for hemorrhage
Dextran · May increase the risk for hemorrhage
NSAIDs · May increase the risk for hemorrhage
Warfarin · May increase the risk for hemorrhage
Antihistamines · May partially counteract heparin's anticoagulant effects
Nitroglycerin (IV) · May partially counteract heparin's anticoagulant effects
Propylene Glycol · May partially counteract heparin's anticoagulant effects
Digoxin · May partially counteract heparin's anticoagulant effects
Tetracyclines · 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

과용량

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.

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