Heparin side effects

One drawback of thrombolytic therapy is a high incidence of reocclusion. In a report using a canine model, inclusion of heparin [9005-49-6] (anticoagulant therapy) in the treatment prevented this side effect (158). The combination of aspirin [50-78-2] (antiplatelet therapy) and streptokinase (thrombolytic therapy) has also shown significant therapeutic advantages (78). Although additional work is needed to estabUsh the thrombolytic advantage of various combinations, preliminary results in this area indicate promise in terms of increased efficacy and reduced side effects. 

Hemorrhage is the main complication that can arise from heparin therapy. Other side effects include Heparin-Induced Thrombocytopenia Syndrome (HITS), local irritation, hypersensitivity reactions and with long-term use, alopecia, hypoaldoster-onism, and osteoporosis. 

Frequent control of coagulability is not necessary with low molecular weight heparin and incidence of side effects (bleeding, heparin-induced thrombocytopenia) is less frequent than with unfractionated heparin. 

Given to patients with a history of typical angina accompanied by either a past medical history of coronary artery disease or ECG/cardiac enzyme changes, low molecular weight heparins (LMWH) were more efficacious in reducing MI and revascularization, but not mortality, with fewer serious side-effects than unfractionated heparin (UFH) (see Magee et al., 2003). 

B. Thrombocytopenia is a frequent side effect association with heparin. This reduction in the level of circulating platelets increases bleeding. Purple toes are encountered during warfarin therapy. Heparin may be administered to pregnant mothers without risk to the fetus. Heparin requires antithrombin III for its anticoagulant action, but does not increase the level of this protein in the blood. 

E3 monoclonal antibody to GPIIb/llla (abciximab) is very useful as an antiplatelet drug in high-risk ACSs and PCI, It can be used in conjunction with reduced levels of heparin and with aspirin (Table I), Patients may uncommonly experience sudden severe thrombocytopenia within the early hours of treatment as a side effect. 

For the past few decades, heparin has been widely used for the prevention of postoperative thiomboemboUsm (6,7). However, there are several adverse side-effects associated with the use of heparin such as bleeding, heparin induced thrombocytopenia, heparin induced thrombosis (8,9) and osteoporosis (10). In addition, the regimen of pioph actic heparin used in the prevention of deep venous thrombosis (DVT) is tedious, requiring 2 to 3 daily injections because of the limited bioavailability and short half-life of heparin when administered subcutaneously. 

You will need to have a complete blood count test before you begin therapy and after you have been on LMWH or fondaparinux for about 5 days this will help detect internal bleeding and the occurrence of a rare side effect of heparin therapy that can decrease a component of your blood called platelets. 

The progression from the isolated mixture heparin to the depolymerized LMW heparins has culminated in a synthesized single chemical entity that can act like heparin and the LMW heparins with fewer side effects. 

The total synthesis of a series single glyco-mimetics of heparin was recently announced (169). One structurally optimized oligosaccharide heparin mimetic is 10 times more potent in vivo than both standard heparin and low molecular weight heparins and is also devoid of the undesired side effect, thrombocytopenia, that is associated with heparin treatment. Thus, chemical synthesis was employed to optimize the length and the charge of the synthetic oligosaccharides. 

Indeed, the optimized oligosaccharide heparin mimetic has 10 times the antithrombotic potency relative to that obtained for heparin but is unable to activate platelets in the presence of plasma from patients with heparin-induced thrombocytopenia and is devoid of other side effects attributed to the anionic charges of heparin, such as hemorrhage. 

The major side effect is bleeding, as is the case with abciximab. The frequency of major bleeding in trials was about 10%, compared with about 9% in a placebo group, which included heparin. Thrombocytopenia has been seen in 0.5 to 1% of patients. 

Tirofiban Tiroflban (Aggrastat), a nonpeptide, small-molecule inhibitor of anePs, appears to have a similar mechanism of action as eptifibatide. Tiroflban has a short duration of action and has efficacy in non-Q-wave myocardial infarction and unstable angina. Reductions in death and myocardial infarction have been about 20% compared to placebo, results similar to those with eptifibatide. Side effects also are similar to those of eptifibatide. The agent is specific to anePs and does not react with the vitronectin receptor. Metaanalysis of trials using anePs inhibitors suggests that their value in antiplatelet therapy after acute myocardial infarction is limited. Tiroflban is administered intravenously at an initial rate of 0.4 pg/kg per minute for 30 minutes, and then continued at 0.1 mg/kg per minute for 12 to 24 hours after angioplasty or atherectomy. It is used in conjunction with heparin. 

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