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Adverse Effects of Heparin

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Heparin - A Century of Progress

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 207))

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Abstract

All the adverse effects of heparins are related to their wide variety of biological activities, with bleeding being the most important safety issue, resulting directly from the potency of heparin as an anticoagulant. However, it is hard to define the bleeding risk, since it depends on numerous parameters including the indication, dosage, method, and duration of heparin application, the clinical study design and definition of bleeding as well as patient characteristics and determinants of bleeding such as type of surgery and co-medication. Nonbleeding complications of heparins are caused by binding of heparin molecules to proteins other than antithrombin and to cells, which is generally more pronounced with unfractionated heparin than with low-molecular-weight heparins. Accordingly, heparin-induced thrombocytopenia, the most severe nonbleeding adverse reaction, occurs about 10 times less with low-molecular-weight heparins than with unfractionated heparin. Frequent and therefore important adverse reactions of heparins are skin lesions resulting from delayed-type hypersensitivity reactions. All the other undesirable effects are discussed as well, but they are mostly clinically irrelevant.

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Abbreviations

ACS:

Acute coronary syndrome

APTT:

Activated partial thromboplastin time

AT:

Antithrombin

aXa:

anti-Factor Xa

BMD:

Bone mineral density

BW:

Body weight

D-ITP:

Drug-induced thrombocytopenic purpura

DTHR:

Delayed-type hypersensitivity reactions

DTI:

Direct thrombin inhibitor

DVT:

Deep vein thrombosis

EIA:

Enzyme immunoassay

EMA:

European Medicines Agency

GAG:

Glycosaminoglycan

GPI:

Glycoprotein IIb/IIIa inhibitors

GUSTO:

Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries

HIPA:

Heparin-induced platelet activation assay

HIT:

Heparin-induced thrombocytopenia

ISTH:

International Society on Thrombosis and Hemostasis

LMWH:

Low-molecular-weight heparin

MHRA:

Medicines and Healthcare Products Regulatory Agency

NSAID:

Nonsteroidal anti-inflammatory drug

OR:

Odds ratio

PCI:

Percutaneous coronary intervention

PE:

Pulmonary embolism

PF4:

Platelet factor 4

RANK:

Receptor activator for nuclear factor-κB

RANKL:

Receptor activator for nuclear factor-κB ligand

RCT:

Randomized controlled trial

RIETE:

Registry of Patients with Venous Thromboembolism

SRA:

Serotonin release assay

TE:

Thromboembolism

TIMI:

Thrombolysis In Myocardial Infarction

UFH:

Unfractionated heparin

VKA:

Vitamin K antagonist

VTE:

Venous thromboembolism

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  1. Pharmazeutisches Institut, Abteilung Pharmazeutische Biologie, Christian-Albrechts-Universität zu Kiel, Kiel Gutenbergstr. 76, 24118, Kiel, Germany

    S. Alban

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  1. S. Alban
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Correspondence to S. Alban .

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  1. School of Pharmacy, University of London, Brunswick Square 29-39, London, WC1N 1AX, United Kingdom

    Rebecca Lever

  2. Standards and Control, National Institute for Biological, Blanche Lane, Potters Bar, Herts., EN6 3QG, United Kingdom

    Barbara Mulloy

  3. King's College London, Sackler Inst. Pulmonary Pharmacology, Waterloo Campus, London, SE1 9NH, United Kingdom

    Clive P. Page

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© 2012 Springer-Verlag Berlin Heidelberg

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Alban, S. (2012). Adverse Effects of Heparin. In: Lever, R., Mulloy, B., Page, C. (eds) Heparin - A Century of Progress. Handbook of Experimental Pharmacology, vol 207. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23056-1_10

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