When administered intravenously UF heparin generally has a half-life approximating 1.5 h. UF heparin is highly negatively charged and binds non-specifically to endothelium, platelets, circulating proteins, macrophages and plastic surfaces. In addition to removal by adherence, Rucaparib datasheet heparin is cleared by both renal and hepatic mechanisms and is metabolized by endothelium. Interestingly, UF heparin has both pro- and anti-coagulant effects. Heparin can be directly procoagulant through platelet activation and aggregation. However, its main effect is anticoagulant,

through its binding to anti-thrombin (anti-thrombin III or heparin-binding factor I). At high doses heparin can also bind to heparin-binding factor II – which can directly inhibit thrombin. When heparin binds anti-thrombin it causes a conformation change, which results in a 1000–40 000× increase in the natural anticoagulant effect of anti-thrombin. Heparin-bound anti-thrombin inactivates multiple coagulation factors including covalent binding of thrombin and Xa and lesser inhibition of VII, IXa, XIa, XIIa. By inactivating thrombin, UF heparin inhibits thrombin-induced platelet activation as well. Of note, UF heparin-bound anti-thrombin inactivates thrombin (IIA) and Xa equally.

Only UF heparin with more than 18 repeating saccharide CX 5461 units inhibits both thrombin and Xa, whereas shorter chains only inhibit Xa. For haemodialysis, UF heparin can be administered, usually into the arterial limb, according to various regimens, but most commonly is administered as a loading dose bolus followed by either an infusion or repeat bolus at 2–3 h.9 The initial bolus is important to overcome the high level of non-specific binding, following which there is a more linear dose : response relationship. The loading dose bolus may be 500 units or 1000

units and infusion may vary from 500 units hourly to 1000 units hourly, depending on whether the prescription is ‘low dose heparin’ or ‘normal heparin’. Heparin administration usually ceases at least 1 h before the end of dialysis. The most important risk of UF heparin is the HIT syndrome (HIT Type II). Other risks or effects attributed to UF heparin that have been reported include why hair loss, skin necrosis, osteoporosis, tendency for hyperkalaemia, changes to lipids, a degree of immunosuppression, vascular smooth muscle cell proliferation and intimal hyperplasia.10–12 Beef-derived heparin can be a risk for the transmission of the prion causing Jacob Creutzfeld type encephalopathy.13 Depolymerized fractions of heparin can be obtained by chemical or enzymatic treatment of UF heparin. These are also anionic glycosaminoglycans but have a lower molecular weight of 2–9 kDa, mostly around 5 kDa – thus consisting of 15 or fewer saccharide units.