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Last Week:
Heparin

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RxMnemonic Anticoagulant
Heparin
Antithrombin Activator • Immediate Anticoagulant • IV
HEP = hep + A-RIN = antithrombin rinse
Break heparin into HEP, A, and RIN. HEP means hep to it, fast, because heparin works in seconds. The A is antithrombin, the protein heparin activates. RIN is rinse: the activated antithrombin rinses out your blood vessels so no clot can form. Hep for fast, A for antithrombin, Rin for rinse clotting factors.
Heparin pharmacology mnemonic illustration
Anticoagulant HEP = fast | A = antithrombin | RIN = rinse
HOW STEP TESTS IT
1
Heparin binds antithrombin and accelerates it, which inactivates thrombin (factor IIa) and factor X. It works by IV and is monitored with PTT, unlike warfarin, which takes days and is monitored with PT/INR.
2
Because it is a large molecule that does not cross the placenta, heparin is the anticoagulant of choice in pregnancy. Its feared complication is heparin-induced thrombocytopenia, and it is reversed with protamine sulfate.
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Practice Question

A 54-year-old man with a pulmonary embolism is started on IV heparin. Despite escalating doses over 24 hours, his PTT fails to rise above baseline. What underlying problem should be suspected?

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