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Adverse Effects of Heparin

  • S. AlbanEmail author
Chapter
Part of the Handbook of Experimental Pharmacology book series (HEP, volume 207)

Abstract

All the adverse effects of heparins are related to their wide variety of biological activities, with bleeding being the most important safety issue, resulting directly from the potency of heparin as an anticoagulant. However, it is hard to define the bleeding risk, since it depends on numerous parameters including the indication, dosage, method, and duration of heparin application, the clinical study design and definition of bleeding as well as patient characteristics and determinants of bleeding such as type of surgery and co-medication. Nonbleeding complications of heparins are caused by binding of heparin molecules to proteins other than antithrombin and to cells, which is generally more pronounced with unfractionated heparin than with low-molecular-weight heparins. Accordingly, heparin-induced thrombocytopenia, the most severe nonbleeding adverse reaction, occurs about 10 times less with low-molecular-weight heparins than with unfractionated heparin. Frequent and therefore important adverse reactions of heparins are skin lesions resulting from delayed-type hypersensitivity reactions. All the other undesirable effects are discussed as well, but they are mostly clinically irrelevant.

Keywords

Heparin Bleeding Heparin-induced thrombocytopenia (HIT) Osteoporosis 

Abbreviations

ACS

Acute coronary syndrome

APTT

Activated partial thromboplastin time

AT

Antithrombin

aXa

anti-Factor Xa

BMD

Bone mineral density

BW

Body weight

D-ITP

Drug-induced thrombocytopenic purpura

DTHR

Delayed-type hypersensitivity reactions

DTI

Direct thrombin inhibitor

DVT

Deep vein thrombosis

EIA

Enzyme immunoassay

EMA

European Medicines Agency

GAG

Glycosaminoglycan

GPI

Glycoprotein IIb/IIIa inhibitors

GUSTO

Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries

HIPA

Heparin-induced platelet activation assay

HIT

Heparin-induced thrombocytopenia

ISTH

International Society on Thrombosis and Hemostasis

LMWH

Low-molecular-weight heparin

MHRA

Medicines and Healthcare Products Regulatory Agency

NSAID

Nonsteroidal anti-inflammatory drug

OR

Odds ratio

PCI

Percutaneous coronary intervention

PE

Pulmonary embolism

PF4

Platelet factor 4

RANK

Receptor activator for nuclear factor-κB

RANKL

Receptor activator for nuclear factor-κB ligand

RCT

Randomized controlled trial

RIETE

Registry of Patients with Venous Thromboembolism

SRA

Serotonin release assay

TE

Thromboembolism

TIMI

Thrombolysis In Myocardial Infarction

UFH

Unfractionated heparin

VKA

Vitamin K antagonist

VTE

Venous thromboembolism

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Pharmazeutisches Institut, Abteilung Pharmazeutische BiologieChristian-Albrechts-Universität zu KielKielGermany

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