Heparin is prescribed in the form of continuous intravenous infusion or in the form of regular intravenous injections, as well as subcutaneously (in the abdomen).
For prophylactic purposes, subcutaneously, 5000 IU / day, at intervals of 8-12 hours. The usual place for injections is the anterolateral wall of the abdomen (in exceptional cases, it is inserted into the upper region of the shoulder or thigh), using a thin The needle, which should be inserted deep, perpendicular, into the fold of the skin,held between the thumb and index finger until the end of the solution. Each time, alternate injection sites (to avoid the formation of a hematoma). The first injection should be performed 1-2 hours before the operation; In the postoperative period, administer within 7-10 days, and if necessary - for a longer time.
The initial dose of heparin administered for therapeutic purposes is usually 5000 IU and is administered intravenously, after which the treatment is continued using intravenous infusions. Supporting doses are determined depending on the method of application:
- with continuous intravenous infusion, appoint 1000-2000 IU / h (24000-48000 IU / day), diluting heparin in a 0.9% solution of sodium chloride;
- with periodic intravenous injections, 5000-10000 IU of heparin is administered every 4 hours.
Adults with thromboses of mild to moderate severity, the drug is administered intravenously at a dose of 40000-50000 IU / day, divided by 3-4 times; with severe thrombosis and embolism-intravenously at a dose of 80000 IU / day, divided into 4 times with an interval of 6 hours. For vital indications, intravenously injected 25000 ME (5 ml), then 20000 IU every 4 hours until a daily dose of 80000 - 120000 ME.When intravenous drip infusion to the daily volume of the infusion solution, it is necessary to add at least 40,000 IU of heparin. Doses of heparin for intravenous administration are selected so that the activated partial thromboplastin time (APTT) was 1.5-2.5 times greater than the control one. When subcutaneous administration of small doses (5000 IU 2-3 times a day) for the prevention of thrombus formation, regular monitoring of APTTV is not required, it increases slightly.
Continuous intravenous infusion is the most effective way of using heparin, better than regular (periodic) injections, because provides more stable hypocoagulation and less often causes bleeding.
When carrying out the extracorporeal circulation, administer a dose of 140-400 IU / kg or 1500-2000 IU per 500 ml of blood. In hemodialysis, 10,000 IU is administered intravenously first, then in the middle of the procedure, another 30,000-50000 ME. For the elderly, especially women, the dose should be reduced.
For children, the drug is administered intravenously drip: at the age of 1-3 months - 800 IU / kg / day, 4-12 months - 700 IU / kg / day, over 6 years - 500 IU / kg / day under the control of APTTV.