Nursing Considerations:

There is the potential for delayed onset of heparin-induced thrombocytopenia (HIT), a serious antibody-mediated reaction resulting from irreversible aggregation of platelets. HIT may progress to the development of venous and arterial thromboses, a condition referred to as heparin-induced thrombocytopenia and thrombosis (HITT). Thrombotic events may be the initial presentation for HITT, which can occur up to several weeks after stopping heparin therapy. Evaluate patients presenting with thrombocytopenia or thrombosis after stopping heparin for HIT and HITT
Draw blood for PTT 4 to 6 hours after dose given subcutaneously.
Avoid I.M. injections of other drugs to prevent or minimize hematoma.
Measure PTT carefully and regularly. Anticoagulation is present when PTT values are 1½ to 2 times the control values.
Monitor platelet count regularly. When new thrombosis accompanies thrombocytopenia (white clot syndrome), stop heparin.
Regularly inspect patient for bleeding gums, bruises on arms or legs, petechiae, nosebleeds, melena, tarry stools, hematuria, and hematemesis.
Monitor vital signs.
Alert: To treat severe overdose, use protamine sulfate (1% solution), a heparin antagonist. Dosage is based on the dose of heparin, its route of administration, and the time since it was given. Generally, 1 to 1.5 mg of protamine per 100 units of heparin is given if only a few minutes have elapsed; 0.5 to 0.75 mg protamine per 100 units heparin, if 30 to 60 minutes have elapsed; and 0.25 to 0.375 mg protamine per 100 units heparin, if 2 hours or more have elapsed. Don't give more than 50 mg protamine in a 10-minute period.
Abrupt withdrawal may cause increased coagulability; warfarin therapy usually overlaps heparin therapy for continuation of prophylaxis or treatment.

Acute Coronary Syndrome: Unstable Angina Haley Weidner 10/25