NEODOSE

INDICATIONS

Maintenance of peripheral arterial and central venous catheter patency. Only continuous infusions (rather than intermittent flushes) have been demonstrated to maintain catheter patency. Treatment of thrombosis. Unilateral renal vein thrombosis (without renal impairment or extension to inferior vena cava) may be managed with supportive care and radiologic monitoring or heparin/low molecular weight heparin. Bilateral renal vein thromboses should be managed with heparin/low molecular weight heparin. Although data are limited, enoxaparin may be preferable to heparin for treatment of thromboses.

 

CONTRAINDICATIONS

Contraindicated in infants with evidence of intracranial or GI bleeding or thrombocytopenia (below 50,000/mm3). Data are insufficient to make specific recommendations regarding anticoagulation therapy. Heparin-induced thrombocytopenia (HIT) has been reported to occur in approximately 1% of newborns exposed to heparin. Heparin-associated antiplatelet antibodies were found in half of the newborns who were both thrombocytopenic and heparin-exposed. Although the thrombocytopenia resolved spontaneously in most patients upon stopping the heparin, a high incidence of ultrasonographic-documented aortic thrombosis was seen. Long term use of therapeutic doses of heparin can lead to osteoporosis. Confirm heparin vial concentration prior to administration of the drug. Fatal hemorrhages have occurred in pediatric patients when the incorrect heparin concentration was administered.

 

ADMINISTRATION

Intravenous: infusion by continuous IV infusion in compatible solution (various concentrations may be used). The concentrations are typically from 100 units/mL to 500 units/mL for loading doses and 10 to 500 units/mL for continuous IV infusion. Make certain correct concentration is used. Avoid intramuscular administration due to possibility of hematoma formation.

Effective October 1, 2009, a revised United States Pharmacopeia (USP) reference standard and test method has resulted in an approximately 10% reduction in heparin potency per USP unit. It is unlikely that the change in potency will have clinical significance. Clinicians should be aware of this change in potency in the event that there are any differences in response to heparin therapy in practice. Manufacturers will provide an identifier (an ‘N’ next to the lot number) on heparin products made under the new USP standards.

 

MONITORING

Follow platelet counts every 2 to 3 days. When treating thromboses, maintain a prolonged aPTT in a range corresponding to an anti-factor Xa level of 0.3 to 0.7 units/mL (usually equivalent to an aPTT of 60 to 85 seconds). Assess for signs of bleeding and thrombosis.