肝素鈉
Heparin Sodium
Unfractionated Heparin (UFH)
別名: Hep-Lock · Hep-Loc U/P · Hepflush-10 · Unfractionated Heparin · UHF · heparinum natricum · sodium heparin · soluble heparin
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
經審核的 v13 劑量證據
結構化劑量計算證據Thromboprophylaxis (extra-label)
須由已驗證獸醫確認
- q6h
NA
必須一併考量的臨床脈絡 (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.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
肝素鈉是一種注射用抗凝血劑，在獸醫學中主要用於治療血栓栓塞性疾病，以及具爭議性的瀰漫性血管內凝血（DIC）。
主要臨床應用包括：
- 血栓預防：有強烈證據支持其可用於降低高危險病患發生大血管血栓的機率。
- DIC 管理：歷史上用於治療 DIC，但目前的共識建議，若 DIC 病患同時伴隨發炎反應，應避免使用。
- 馬匹醫學：用於預防蹄葉炎、治療 DIC，以及作為腹腔灌洗液以預防術後腸道沾黏。
臨床要點：與低分子量肝素（LMWH）相比，未分級肝素（UFH）的藥代動力學特徵變異性極大。UFH 需要密集監測 aPTT 或抗 Xa 因子活性，以確保療效並避免災難性出血。
作用機轉
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.
安全性與警告
禁忌症
- 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
不良反應
- 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
注意事項
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).
藥物交互作用
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
監測
- 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
藥物動力學
吸收
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%.
分佈
Extensively protein bound, primarily to fibrinogen, low-density lipoproteins, and globulins. Does not appreciably cross the placenta or enter milk.
代謝
Metabolic fate is not completely understood. Partially metabolized by the liver and inactivated by the reticuloendothelial system.
排除
Eliminated via hepatic metabolism and the reticuloendothelial system. Dogs with renal insufficiency may have faster elimination rates.
過量
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.
可用產品
劑型
- 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
人用標示
- 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
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store solutions at room temperature (15-30°C). Do not freeze. Avoid excessive exposure to heat.
飼主須知
肝素是一種強效的血液稀釋劑，用於治療或預防危及生命的血栓。
- 住院照護：由於使用肝素需要密集的監測（頻繁抽血檢查凝血時間），且其治療的疾病通常相當嚴重，因此這種藥物幾乎只在獸醫院的住院環境中由專業人員使用。
- 出血風險：最顯著的風險是出血。如果您的寵物帶著類似肝素的藥物出院，請密切觀察是否有任何瘀傷、牙齦出血、血尿或血便，或是極度疲倦的跡象，若有發現請立即聯繫您的獸醫師。
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