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| Interactions: | AbciximabAdverse Effect: Excessive bleedingClinical Management: Before infusing Abciximab, platelet count, prothrombin time and APTT should be measured to identify pre-existing hemostatic abnormalities. During and following Abciximab therapy, platelet counts and the extent of Heparin anticoagulation, as determined by activated clotting time or APTT should be monitored closely.
AspirinAdverse Effect: an increased risk of bleedingClinical Management: Heparin and aspirin should only be used concurrently when the potential benefit outweighs the significant risk of bleeding associated with this combination. If used, monitor partial thromboplastin time closely. Acetaminophen, which does not affect platelet function, is a useful alternative for mild analgesia and antipyresis.
CefoperazoneAdverse Effect: increased risk of bleedingClinical Management: Patients receiving heparin and cefoperazone concurrently should have careful monitoring of the anticoagulant therapy. In patients who are at high risk of bleeding, the use of an alternative antimicrobial agent would be advisable.
Glyceryl TrinitrateAdverse Effect: decreased anticoagulant effectivenessClinical Management: In patients who are being anticoagulated with heparin, the addition of intravenous nitroglycerin may result in subtherapeutic levels of anticoagulation. This effect should be anticipated and may require an increased heparin infusion rate with or without a heparin bolus. Partial thromboplastin times should be assessed with the initiation and withdrawal of cotherapy and at regular intervals thereafter to ensure adequate anticoagulant response.
RtpaAdverse Effect: excessive bleedingClinical Management: Alteplase is contraindicated in patients who received heparin within 48 hours preceding the onset of a stroke and if the patient has an elevated activated partial thromboplastin time (aPPT) at the time of presentation. The combination of alteplase and heparin significantly raises the risk of internal or external hemorrhaging.
UrokinaseAdverse Effect: an increased risk of bleedingClinical Management: Heparin should not be coadministered with intravenous doses of urokinase.
WarfarinAdverse Effect: an increased risk of bleedingClinical Management: In patients receiving heparin and warfarin continuously, blood for prothrombin time determination should be drawn a minimum of four to six hours after the last bolus heparin dose. |
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