Safe Treatment Roadblocks: Heparin Hazards

The term heparin refers to low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH).

Did You Know:

• One-third of all hospitalized patients or 12 million individuals are exposed to heparin annually (Eke, 2018), and the cost of adverse events from heparin administration adds appropriately 45% or $2.5 billion to the cost of hospitalization (Spector, Limcangco, Furukawa, & Encinosa, 2017)
• Intravenous heparin is considered one of the highest-risk medications used in the in-patient setting. Safe use of heparin requires a diligent approach:
  • Weight-based dosing
  • Frequent monitoring of the patient’s blood clotting ability
  • Lab-based adjustment of dosing
  • Assessment for sources of bleeding
• (Agency for Healthcare Research and Quality (AHRQ), 2017)
  The Institute for Safe Medication Practices (ISMP) regularly publishes lists of high-risk drugs and strategies to help reduce the risk of errors (Institute for Safe Medication Practices, 2014)
• The Joint Commission (TJC) is active in heparin adverse drug event prevention. The Joint Commission’s 2018 National Patient Safety Goals include an anticoagulant safety goal: NPSG.03.05.01 (Fenner, 2018)
• Heparin sodium is used in many situations to:
  • Diminish the clotting ability of blood – post-operative clot prophylaxis, heart attack
  • Prevent existing clots from getting bigger – deep vein thrombosis, heart attack, pulmonary embolism
  • Prevent clot formation – post-operative clot prophylaxis

Heparin Does Not:

• Dissolve blood clots that have already formed
• Affect platelet count, unless Heparin-Induced Thrombocytopenia occurs

Heparin inhibits or inactivates reactions on the clotting cascade that lead to coagulation and development/stabilization of fibrin clots. These actions can lead to severe bleeding when the heparin dose is too high. To prevent bleeding, heparin is usually managed utilizing a standardized protocol based on aPTT values.

Healthcare providers need to be aware of the complications of heparin administration such as:

• Episodes of bleeding may occur during and after heparin administration
• Allergic episodes are medical emergencies
• Immunologically-induced complications, such as heparin-induced thrombocytopenia may be life-threatening

Do you know the risk factors related to heparin administration, how the types of heparin differ, how to treat heparin-related adverse drug reactions, and how to prevent these adverse drug reactions? If not, or if you need a refresher, review the RN.com course Hazards of Heparin.

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^References

^{Agency for Healthcare Research and Quality. (2017). Medication Errors.}

^{Eke, S. (2018). Heparin-induced thrombocytopenia.}

^{Fenner, K. (2018). The Joint Commission’s Hospital National Patient Safety Goals for 2018.} 

^{Institute of Safe Medication Practices. (2014). High-alert medications in acute care Spector, W, Limcangco, R, Furukawa, M, & Encinosa, W. (2017). The marginal costs of adverse drug events associated with exposures to anticoagulants and hypoglycemic agents during hospitalization.}