Stanhep 25 Heparin Sodium Injection

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What Is Stanhep 25?

Stanhep 25 is unfractionated heparin (UFH) sodium 25,000 IU per 5 mL vial injection from a WHO-GMP certified manufacturer, supplied as 1-10 vials. UFH is the prototype parenteral anticoagulant in clinical use since the 1930s. Despite the rise of LMWH and DOACs it retains key roles where rapid onset, rapid offset, and protamine reversibility matter.

How Heparin Works

Heparin binds antithrombin III via its pentasaccharide sequence and accelerates antithrombin’s inhibition of thrombin (factor IIa) and factor Xa about 1,000-fold. UFH inhibits IIa and Xa roughly equally; LMWHs preferentially inhibit Xa. Onset is immediate when given IV; subcutaneous onset is 20-30 min. Plasma half-life is 60-90 min, dose-dependent, allowing rapid offset.

Approved Uses

• Acute coronary syndrome (NSTEMI / unstable angina, STEMI) — with antiplatelets and PCI
• Acute venous thromboembolism (DVT, PE) — especially when LMWH is unsuitable (severe renal failure, anticipated procedures)
• Peri-operative bridging in patients on long-term anticoagulation undergoing surgery
• Cardiopulmonary bypass and ECMO circuits
• Continuous renal replacement therapy (CRRT) and haemodialysis — circuit anticoagulation
• Catheter and line patency — low-dose flush (separate, lower-strength preparations)
• Atrial fibrillation cardioversion bridging

Dosage and Monitoring

Monitor aPTT or anti-Xa (0.3–0.7 IU/mL) every 6 hours after initiation or dose change, then daily once stable. Check baseline FBC, PT, aPTT, fibrinogen, renal and hepatic function.

Heparin-Induced Thrombocytopenia (HIT)

Bivirkninger

• Bleeding (major bleeding rate ~5% on therapeutic IV heparin)
• Heparin-induced thrombocytopenia (HIT) — type II, immune-mediated, life-threatening
• Mild benign drop in platelets (HIT type I, non-immune, transient)
• Hyperkalaemia (aldosterone suppression, especially in diabetes and renal failure)
• Osteoporosis with prolonged use >3 months
• Injection-site bruising / haematoma (SC route)
• Hypersensitivity reactions, rarely anaphylaxis
• LFT elevation

Kontraindikationer

• Active major bleeding
• Known HIT or history of HIT (use a non-heparin anticoagulant)
• Severe thrombocytopenia (platelets <50×10⁹/L)
• Severe uncontrolled hypertension
• Recent intracranial, ophthalmic, or major surgery with bleeding risk
• Peptic ulcer with active bleeding, oesophageal varices
• Hypersensitivity to heparin or pork products

Lægemiddelinteraktioner

• Other anticoagulants / antiplatelets (warfarin, DOACs, aspirin, clopidogrel, NSAIDs, fibrinolytics) — additive bleeding risk; combine only when clinically indicated under specialist supervision.
• Glyceryl trinitrate IV infusion — may reduce heparin effect; aPTT monitoring as usual.
• SSRIs/SNRIs — modest additive bleeding risk.

Reversal: Protamine Sulfate

For major bleeding or pre-emergency reversal, protamine sulfate neutralises heparin: 1 mg protamine per 100 IU heparin given in the previous 2-3 hours, slow IV (max 50 mg over 10 min) to avoid hypotension and anaphylactoid reactions. Maximum single dose 50 mg; recheck aPTT after 5-15 min. Higher risk of protamine reaction in patients with prior NPH insulin exposure, fish allergy, or vasectomy.

Pregnancy and Breastfeeding

Heparin and LMWH do not cross the placenta and are the anticoagulants of choice in pregnancy. LMWH is preferred for outpatient use. Breastfeeding: heparin is not excreted in breast milk (large molecule) — safe.

Opbevaring

Store Stanhep 25 below 25°C, do not freeze. Once a vial is broached, follow institutional sterility protocols. Keep out of reach of children.

Ofte stillede spørgsmål

Can I use Stanhep 25 at home?

No. Stanhep 25 is a high-strength multi-dose vial (25,000 IU/5 mL) intended for hospital IV infusion or in-patient SC dosing under aPTT or anti-Xa monitoring. At-home anticoagulation is normally LMWH (enoxaparin, dalteparin) or a DOAC.

What is the difference between heparin and LMWH?

Unfractionated heparin (UFH) is a heterogeneous mixture inhibiting IIa and Xa equally, with a short half-life and aPTT monitoring. LMWHs (enoxaparin, dalteparin) are smaller, preferentially inhibit Xa, have a longer predictable half-life, can be given subcutaneously without monitoring in most patients, and are first-line outpatient choice. UFH is preferred when rapid offset, severe renal failure, or protamine reversibility matter.

What is HIT and how is it treated?

Heparin-induced thrombocytopenia is an immune reaction (anti-PF4/heparin antibodies) usually on day 5-10 of heparin, causing a paradoxical pro-thrombotic state. Stop all heparin (including flushes), avoid warfarin until platelets recover, and start a non-heparin anticoagulant (argatroban, danaparoid, fondaparinux, or bivalirudin). Confirm with anti-PF4 ELISA and serotonin release assay.

How is heparin reversed?

Protamine sulfate. 1 mg per 100 IU heparin given in the previous 2-3 hours, slow IV. Maximum single dose 50 mg. Recheck aPTT 5-15 min after.

Why monitor aPTT?

UFH dose response is unpredictable because it binds plasma proteins variably. The aPTT reflects intrinsic-pathway anticoagulation; target is 1.5-2.5× baseline (typically 50-70 sec) for therapeutic anticoagulation. Anti-Xa (0.3-0.7 IU/mL) is the alternative target where available.

Is heparin safe in pregnancy?

Yes — heparin (and LMWH) do not cross the placenta and are the anticoagulants of choice when anticoagulation is needed in pregnancy. Warfarin is teratogenic; DOACs lack pregnancy data.

Can heparin cause hyperkalaemia?

Yes — especially in diabetes and renal failure, due to aldosterone suppression. Check potassium at baseline and during prolonged therapy.

What if a child accidentally swallows a heparin vial?

Heparin is not absorbed orally — oral ingestion is essentially harmless from an anticoagulation standpoint. Take the child to A&E for assessment regardless. Parenteral exposure is a different matter.

How is heparin used during dialysis?

Continuous infusion or bolus dosing into the dialysis circuit prevents clotting in the extracorporeal system. Doses are unit-protocol-driven; ACT or aPTT may be monitored during the run.

Where can I buy Stanhep 25 online?

You can buy Stanhep 25 (25,000 IU per 5 mL vial, 1-10 vials) from MedsBase with discreet packaging and worldwide shipping. This is a hospital-use parenteral product — it must be administered by trained clinicians.

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