Heparin is a commonly used injectable anti-coagulant to help prevent clots from forming or getting larger. Patients often receive injections of heparin routinely in the hospital to prevent deep venous thrombosis (DVT). DVTs are a significant cause of morbidity and potentially mortality if they embolize (break off and travel in the blood) to the lungs, brain or other organs. Treatment or prophylaxis with heparin does come with it's own side effects.
Bleeding
Since heparin inhibits the formation of clots, there is an inherent risk of bleeding. Bleeding can occur into any body orifice or from any location in the body. Heparin can often exacerbate post-operative bleeding especially at the incision site. Bleeding into the kidney can cause hematuria (blood in the urine).
Heparin Induced Thrombocytopenia (HIT)
Heparin-Induced Thrombocytopenia (HIT) is a side effect of heparin administration. In HIT, the body forms antibodies that cause the body to form clots and decrease blood platelet levels. The clots that form in either arteries or veins can involve any organ in the body including the heart, brain, lungs or kidneys. Dr. Marilena Antonopoulos of the Pharmacy Department at Long Island University in Brooklyn, NY wrote in "Pharmacy and Therapeutics" that other than bleeding, thrombocytopenia (low platelets) remains the next most significant side effect of heparin. It can become a very serious condition that requires prompt medical attention.
Cardiovascular/Respiratory
Most likely related to thrombosis, the allergic vasospastic reaction can cause chest pain and possible ischemia (decreased blood flow to an area of the heart).
Heparin can produce a variety of pulmonary manifestations including asthma, bronchospasm, hemoptysis, and pulmonary hemorrhage.
Central Nervous System
Some common central nervous system side effects include fevers, chills, and headache. These symptoms prove common with many medications other than heparin.
Dermatologic
Skin manifestations of heparin vary. Hair loss, alopecia, can result due to heparin and may only be a short-term side effect that improves once off the medication. Bruising typically refers to spontaneous hemorrhage into the skin or from a mild trauma. Heparin can cause death to skin cells (cutaneous necrosis). Eczema, Other dermatologic side effects of heparin therapy include urticaria, purpura, and erythematous plaques.
Endocrine/Metabolic
Hemorrhage (bleeding) into an endocrine organ can lead to dysfunction of that organ. The adrenals and ovaries often prove susceptible to hemorrhage and subsequent dysfunction. Hyperkalemia(elevated potassium) can occur if there is suppression of making aldosterone (an hormone made by the adrenals that works on the kidney). Patients who discontinue heparin can often develop a rebound hyperlipidemia (elevated blood lipid levels including triglycerides and cholesterol).
Genitourinary
A known genitourinary side effect of heparin, although not common, includes frequent or persistent erections.
Effects on the Liver
Elevation of liver enzymes is a side effect of heparin. Once treatment ceases the enzyme levels usually return to normal/baseline.
Local Injection Site Reactions
Heparin is an injectable drug, the most common site of injection includes into the skin of the abdomen. At the site of the injection, patients can develop irritation, erythema (redness), pain, hematoma (pooling of blood) and ulceration.
Chronic Therapy Side Effects
Two known side effects of long-term use of heparin include peripheral neuropathy and osteoporosis. Peripheral neuropathy refers to having a motor/sensory deficit. Osteoporosis refers to decreased bone mineral density.
Allergic Type Reaction
Heparin similarly to other medications can produce allergic reactions in patients. Dr Andreas Bircher of the Department of Dermatology at University Hospital Basel, Switzerland describes in, the journal "Allergy" that allergic reactions to heparin prove rare. Patients have reported urticaria (hives), rash, conjunctivitis, and anaphylaxis (severe allergic reaction).
Heparin Resistance
Heparin is monitored by the aPTT test. When greater than 35,000 units is required over 24 hours to reach a therapeutic aPTT, patients may have heparin resistance. This occurs frequently in patients with antithrombin deficiency, increased heparin clearance, heparin-binding proteins, elevated factor VIII and fibrinogen.
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