Heparin
Sources réglementaires consultées
Indications approuvées
- Soulagement symptomatique local chez l'adulte des troubles veineux superficiels, notamment lourdeur et tension des jambes avec varices, ainsi que des hématomes superficiels dus à des coups.
Contre-indications
Absolues
- Hypersensibilité à l'héparine sodique ou à l'un des excipients.
- Application sur les muqueuses, les ulcères ou les plaies ouvertes ou infectées.
Mises en garde cliniques
- Mise en garde majeure · Utiliser uniquement sur peau intacte, éviter les yeux et ne pas prolonger le traitement ni l'appliquer sur de grandes surfaces ; l'utilisation prolongée peut provoquer une sensibilisation. — https://cima.aemps.es/cima/dochtml/ft/58678/FT_58678.html
- Mise en garde majeure · En cas de troubles veineux thrombotiques, appliquer doucement sans masser. Faire preuve d'une prudence particulière ou éviter selon le jugement clinique en présence de manifestations hémorragiques ou de troubles importants de l'hémostase. — https://cima.aemps.es/cima/dochtml/ft/58678/FT_58678.html
- Mise en garde majeure · Faire preuve d'une prudence particulière en raison d'un risque hémorragique accru en cas d'hypertension sévère, d'ulcère gastroduodénal, de troubles hémorragiques congénitaux ou acquis — tels que l'hémophilie, la thrombopénie ou certains purpuras vasculaires — et pendant les règles. — https://cima.aemps.es/cima/dochtml/ft/58678/FT_58678.html
Interactions médicamenteuses
- ModéréeAINS, dextran, dipyridamole et autres médicaments affectant la fonction plaquettaire
Mécanisme: Ils peuvent augmenter l'effet hémorragique de l'héparine.
Recommandation: Utiliser avec prudence et surveiller les signes de saignement.
https://cima.aemps.es/cima/dochtml/ft/58678/FT_58678.html
- ModéréeNitroglycérine, glycosides cardiaques, nicotine, quinine et tétracyclines
Mécanisme: Ils peuvent interférer avec l'effet anticoagulant de l'héparine.
Recommandation: Évaluer l'association et surveiller la réponse clinique.
https://cima.aemps.es/cima/dochtml/ft/58678/FT_58678.html
Effets indésirables
Communs (≥1%)
Dermatite de contact · Irritation locale · Réactions allergiques locales · Prurit
Rares mais graves
Très rare : nécrose cutanée au site d'application
Grossesse et allaitement
Pendant la grossesse ou l'allaitement, utiliser uniquement si cela est strictement nécessaire et après évaluation professionnelle ; l'héparine ne traverse pas le placenta et ne passe pas dans le lait maternel.
Bibliographie récente (PubMed)
Critically ill adults are at increased risk of VTE, including DVT, and pulmonary embolism. Various agents exist for venous thromboprophylaxis in this population. What is the comparative efficacy and safety of prophylaxis agents for prevention of VTE in critically ill adults? Systematic review and network meta-analysis of randomized clinical trials (RCTs) evaluating efficacy of thromboprophylaxis agents among critically ill patients. We searched six databases (including PubMed, EMBASE, and Medline) from inception through January 2021 for RCTs of patients in the ICU receiving pharmacologic, mechanical, or combination therapy (pharmacologic agents and mechanical devices) for thromboprophylaxis. Two reviewers performed screening, full-text review, and extraction. We used the Grading of Recommendations Assessment, Development, and Evaluation to rate certainty of effect estimates. We included 13 RCTs (9,619 patients). Compared with control treatment (a composite of no prophylaxis, placebo, or compression stockings only), low-molecular-weight heparin (LMWH) reduced the incidence of DVT (OR, 0.59 [95% credible interval [CrI], 0.33-0.90]; high certainty) and unfractionated heparin (UFH) may reduce the incidence of DVT (OR, 0.82 [95% CrI, 0.47-1.37]; low certainty). LMWH probably reduces DVT compared with UFH (OR, 0.72 [95% CrI, 0.46-0.98]; moderate certainty). Compressive devices may reduce risk of DVT compared with control treatments; however, this is based on low-certainty evidence (OR, 0.85 [95% CrI, 0.50-1.50]). Combination therapy showed unclear effect on DVT compared with either therapy alone (very low certainty). Among critically ill adults, compared with control treatment, LMWH reduces incidence of DVT, whereas UFH and mechanical compressive devices may reduce the risk of DVT. LMWH is probably more effective than UFH in reducing incidence of DVT and should be considered the primary pharmacologic agent for thromboprophylaxis. The efficacy and safety of combination pha
Heparin has been used extensively as an antithrombotic and anticoagulant for close to 100 years. This anticoagulant activity is attributed mainly to the pentasaccharide sequence, which potentiates the inhibitory action of antithrombin, a major inhibitor of the coagulation cascade. More recently it has been elucidated that heparin exhibits anti-inflammatory effect via interference of the formation of neutrophil extracellular traps and this may also contribute to heparin's antithrombotic activity. This illustrates that heparin interacts with a broad range of biomolecules, exerting both anticoagulant and nonanticoagulant actions. Since our previous review, there has been an increased interest in these nonanticoagulant effects of heparin, with the beneficial role in patients infected with SARS2-coronavirus a highly topical example. This article provides an update on our previous review with more recent developments and observations made for these novel uses of heparin and an overview of the development status of heparin-based drugs. SIGNIFICANCE STATEMENT: This state-of-the-art review covers recent developments in the use of heparin and heparin-like materials as anticoagulant, now including immunothrombosis observations, and as nonanticoagulant including a role in the treatment of SARS-coronavirus and inflammatory conditions.
Haemodialysis (HD) requires safe and effective anticoagulation to prevent clot formation within the extracorporeal circuit during dialysis treatments to enable adequate dialysis and minimise adverse events, including major bleeding. Low molecular weight heparin (LMWH) may provide a more predictable dose, reliable anticoagulant effects and be simpler to administer than unfractionated heparin (UFH) for HD anticoagulation, but may accumulate in the kidneys and lead to bleeding. To assess the efficacy and safety of anticoagulation strategies (including both heparin and non-heparin drugs) for long-term HD in people with kidney failure. Any intervention preventing clotting within the extracorporeal circuit without establishing anticoagulation within the patient, such as regional citrate, citrate enriched dialysate, heparin-coated dialysers, pre-dilution haemodiafiltration (HDF), and saline flushes were also included. We searched the Cochrane Kidney and Transplant Register of Studies up to November 2023 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. Randomised controlled trials (RCTs) and quasi-randomised controlled studies (quasi-RCTs) evaluating anticoagulant agents administered during HD treatment in adults and children with kidney failure. Two authors independently assessed the risk of bias using the Cochrane tool and extracted data. Treatment effects were estimated using random effects meta-analysis and expressed as relative risk (RR) or mean difference (MD) with 95% confidence intervals (CI). Evidence certainty was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach (GRADE). We included 113 studies randomising 4535 participants. The risk of bias in each study was adjudicated
Heparin, an old but first-line anticoagulant, has been used over a century. It is a heterogeneous, linear, highly sulfated, anionic glycosaminoglycan with a broad distribution in relative molecular weight and charge density. These structural properties allow heparin to selectively interact with multiple proteins, leading to heparin's various pharmacological functions, such as anticoagulant, anti-viral, anti-tumor and anti-inflammatory activities. Clinical data suggest that unfractionated heparin or low molecule weight heparin could decrease mortality in COVID-19 patients with sepsis-induced hypercoagulation through the anticoagulant, anti-viral and anti-inflammatory activities of these drugs. Thus, the non-anticoagulant activity of heparin has again aroused attention. This review highlights recent advances in the preparation of heparin-derived drugs and clinical research on its non-anticoagulant properties over the past decade, to further the development and utilization of these important drugs.