Classification of the World Health Organization (WHO) of unwanted drug reactions by frequency of development: very often (> 1/10 appointments); often (> 1/100 and <1/10 of appointments); infrequently (> 1/1000 and <1/100 of prescriptions); rarely (> 1/10000 and <1/1000 appointments); very rarely (<1/10000), including individual messages.
Hemorrhagic complications: Develop very often. The most typical bleeding from the digestive tract, urinary tract, from the sites of sodium heparin, from postoperative wounds, as well as hemorrhages in areas undergoing pressure. Also, hemorrhages may develop in other internal organs, incl. in the adrenal glands (with the development of acute adrenal insufficiency), retroperitoneal space, ovaries.More frequent bleeding occurs in patients older than 60 years (especially in women).
Allergic reactions: infrequent - skin hyperemia, rash, itching and burning sensation in the soles, pain in the extremities, hyperthermia, urticaria, rhinitis, conjunctivitis, dyspnea, bronchospasm, angioedema; very rarely - anaphylactic shock.
Reactions at the site of administration: often - irritation, soreness, hyperemia of the tissues, minor hematoma and ulceration at the injection site, infrequently - histamine-like reactions (including necrosis of the skin at the injection site), very rarely - calcification of soft tissues at the site of administration (mainly in patients with severe chronic renal insufficiency).
Heparin-induced thrombocytopenia (HIT): a severe immune reaction caused by the formation of antibodies and leading to irreversible aggregation of platelets. It can develop as a background of heparin therapy (rarely), and for several weeks after its termination (very rarely). Clinical manifestations: venous and arterial thromboses (including deep vein thrombosis of legs, pulmonary embolism, thrombosis of cerebral veins, stroke, myocardial infarction,thrombosis of mesenteric and renal arteries, thrombosis of the arteries of the extremities with the development of gangrene).
Laboratory diagnostics: It should be determined the number of platelets before the appointment of heparin sodium, on the first day of treatment, and then every 2-3 days during the entire treatment period (especially from 6 to 14 days of therapy). With a decrease in the number of platelets below 100 * 109/ l and / or with the development of recurrent thrombosis should immediately be canceled heparin sodium. If necessary, an alternative antithrombotic therapy should be prescribed.
Therapy and prevention: When a GIT occurs heparin sodium should be immediately canceled. The patient should be warned that in the future he can not be appointed unfractionated heparin (including hemodialysis) and low molecular weight heparins. If the patient needs antithrombotic therapy, then other drugs should be used.
Other undesirable phenomena:
From the central nervous system and sensory organs: infrequently, headache, headache.
From the cardiovascular system: infrequently - lowering blood pressure.
From the digestive system: infrequent - loss of appetite, nausea, vomiting, diarrhea, often - an increase in the content of "liver" transaminases (ACT and ALT) in blood plasma.
From the hematopoiesis: often - moderate thrombocytopenia (platelet content 150-100 * 109/ l) not associated with the production of antibodies and not accompanied by thrombosis (may occur in 6-30% of patients receiving heparin); rarely - reversible eosinophilia.
From the musculoskeletal system: rarely - osteoporosis (with prolonged use of sodium heparin), spontaneous fractures of bones.
From the endocrine system: rarely - hypoaldosteronism (due to inhibition of aldosterone synthesis).
From the side of water-electrolyte exchange: rarely - reversible potassium retention, metabolic acidosis.
Other: infrequently - transient alopecia, very rarely - priapism.
Laboratory indicators: often - a reversible increase in the content of "liver" transaminases (ACT and ALT); infrequently, an increase in free fatty acids after heparin withdrawal, an increase in thyroxin levels in the blood plasma, a false decrease in cholesterol, a false increase in glucose and incorrect results of bromsulfalein test.
If any of the side effects indicated in the instructions for use are aggravated, or if there are other undesirable effects not listed in the instructions, you should immediately notify the attending physician.