Heparin is an immediate-acting injectable anticoagulant used to prevent and treat clots: deep vein thrombosis, pulmonary embolism, and to keep catheters and dialysis machines from clotting.
Also known as: Heparina sódica, Liquemine
Heparin plus ibuprofen significantly increases bleeding risk (anticoagulant effect plus platelet/gastric mucosa effects).
NSAIDs inhibit platelet aggregation and injure gastric mucosa; Prontuário Annex 7 (Salicylates): "Heparin: greater bleeding tendency"; the heparin label lists NSAIDs as aggravating agents.
Bleeding signs, full blood count (Hb, platelets), aPTT in heparinised patients.
Bruising, gastrointestinal bleeding, dark urine, Hb drop.
Avoid the combination; if analgesia is needed, prefer paracetamol; if unavoidable, use the shortest duration and monitor bleeding signs and blood count.
DailyMed — Heparin Sodium Injection label [RLD], Warnings/Drug Interactions: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=301b19bc-21c2-4a35-9d29-569b08d855c4; INFARMED Prontuário Terapêutico (11th ed., 2012), Annex 7 — Salicylates: "Heparin: greater bleeding tendency with aspirin".
No documented food or drink interactions.
Heparin is contraindicated in active bleeding — potentially fatal worsening.
Stop and assess before each dose; reverse with protamine if needed.
Site monograph (heparin — caution in active ulcer, recent haemorrhagic stroke).
Prior HIT is an absolute contraindication — re-exposure precipitates paradoxical thrombosis.
Monitor platelets day 0, 3, 5, 7; if HIT suspected, stop and use an alternative (fondaparinux).
Site monograph (heparin — monitor platelets; HIT: stop, do not switch to LMWH).
Heparin is contraindicated in active peptic ulcer — elevated bleeding risk.
Gastroprotection and reassess indication.
Site monograph (heparin — active ulcer); EMC-UK heparin SmPC 4.3.
Annex 1 records "It is the anticoagulant of choice if indicated during pregnancy" (factor B) — it does not cross the placenta due to its high molecular weight. Maternal risks to monitor: osteoporosis with prolonged use (>1 month), thrombocytopenia (HIT) and haemorrhage; multidose vials contain benzyl alcohol which manufacturers recommend avoiding in pregnancy.
Anticoagulant of choice in pregnancy (VTE, valve prostheses); use unfractionated heparin or LMWH at adjusted dose; monitor platelets and bone density if prolonged use; prefer single-dose vials.
Compatible: "present in milk, but bioavailability in milk is greatly reduced" (Annex 2, l. 42695-97) — heparin is destroyed in the infant gut.
Prontuário Terapêutico INFARMED — Annex 1: "Heparin sodium" (l. 40469-71, factor B); Annex 2 (l. 42695-97).
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Immediate anticoagulation (dose-dependent aPTT rise); prevention and treatment of arterial and venous thromboses.
Activates antithrombin III by binding specific pentasaccharide sequences: inhibition of thrombin (IIa), Xa, IXa, XIa and XIIa; effect limited to thrombin-dependent fibrins.
IV/SC exclusive; dose-dependent SC bioavailability (20–60% at prophylactic dose; > 90% at therapeutic dose).
No classic hepatic metabolism; degradation by reticuloendothelial desulphation and depolymerisation; renal excretion.
~ 60–90 min IV (dose-dependent; longer at high dose).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
