Heparin ointment for bruises

External medicines with heparin, first of all, are an anticoagulant, antithrombotic method of treating many diseases. Heparin is an active anticoagulant that blocks the aggregation and synthesis of platelets, thrombin, sodium heparin is able to prevent the production of fibrin, thereby ensuring normal blood consistency, preventing the formation of blood clots.

Heparin ointment for bruises has an anti-inflammatory and pronounced antithrombotic effect, without irritating the skin in the area of injury. In addition, a product with heparin can relieve swelling due to the antiexudative effect and accelerate the regeneration process of the affected subcutaneous tissue.

External preparations with heparin include components that facilitate intensive absorption and penetration of active substances into the bloodstream; these are, as a rule, benzyl nicotinate and benzocaine for local anesthetic action.

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Indications for use

In heparin ointment, the most active component is heparin, a substance that inhibits plasma blood clotting factors. Heparin as a coagulant slows down the blood clotting process (coagulation), helping to improve rheological parameters, preventing the formation of new blood clots. In the form of an ointment or gel, heparin is used as one of the methods of external treatment of diseases associated with thrombus formation in the vascular system.

Heparin ointment (heparin ointment) belongs to the group of direct anticoagulants, it contains the following components:

• Heparin sodium (sodium heparin).
• Benzocaine (benzocaine).
• Benzylnicotinate (benzylnicotinate).
• Auxiliary components.

Heparin ointment has the following indications for use:

• Preventive treatment of thrombophlebitis.
• Prevention of thrombosis in the background of varicose veins.
• Postpartum complications in the form of hemorrhoids.
• External (outer) hemorrhoids.
• Periphlebitis is an inflammatory process in the walls of the veins.
• Post-injection phlebitis.
• Mastitis.
• Trophic ulcers.
• Lymphadenitis.
• Hematomas.
• Migrating phlebitis.
• Bruises, closed injuries, including damage to joints, tendons, ligaments, muscles.
• Aseptic type infiltrates.

How does heparin ointment work?

• Sodium heparin reduces swelling, has a local anti-inflammatory effect, affects the rate of thrombus resorption. The component works directly in the bloodstream as an inhibitor of the biosynthesis of coagulation factors - thrombins.
• Benzyl nicotinate promotes vasodilation, which ensures good absorption of heparin.
• Benzocaine reduces pain symptoms that occur with vascular thrombosis and local inflammatory processes.

Thus, all external agents containing heparin have a positive effect on blood flow and the state of the vascular system, helping to overcome the inflammatory process and associated dysfunctions of the tissue blood supply system.

Pharmacodynamics

Heparin as the main active ingredient of the ointment is primarily an endogenous anticoagulant component of direct action. The pharmacodynamics of heparin is due to its ability to inhibit the entire process of blood coagulation by forming complexes with the following substances:

• Procoagulants.
• Antithrombin III.
• All components of the fibrinolysis system - plasmin, activators and inhibitors of fibrinolysis.

In addition to preventing blood clots, all heparin-containing medications have an antiproliferative effect – they suppress the growth and proliferation of new, often atypical cells at the site of injury.

Once in the systemic bloodstream, heparin begins to activate the plasma protein factor (antithrombin), which in turn inhibits the process of coagulation and thickening of the blood. The pharmacodynamics of Heparinum are associated with the following changes in the bloodstream:

• Activation of the production of heparin cofactor, antithrombin.
• Formation of complexes with fibrinolytic proteins.
• Binding of thrombins formed in the blood with heparin complexes.
• Slowing down of prothrombinase production.
• Inhibition of plasma factors – Christmas factor (factor IX) – antihemophilic globulin.
• Inhibition of factor X – Stewart-Prower factor.
• Inhibition of activation of Rosenthal factor (factor XI) – a pre-thromboplastin component.
• Inhibition of factor XII – Hageman factor.
• Binding of complexes and inhibition of prothrombinase process factors leads to inhibition of thrombin formation.
• Stabilization of fibrinogen levels and inhibition of its conversion to fibrin.
• Reduction of the bond between thrombin and fibrinogen due to the negative molecular charge of heparin.
• Inhibition of fibrin stabilizing factor (XIII) - plasma transglutaminase.
• Maintaining the integrity and stability of the vascular wall by replenishing its electronegative potential.
• It has a certain immunosuppressive effect on the inflammatory process at the site of the injury.

In addition to the fact that heparin ointment prevents thrombus formation, its pharmacodynamics are associated with the disaggregation of existing thrombus clots. As a result, microcirculation is activated in damaged tissues, bruises and hematomas are absorbed faster, swelling subsides and general trophism improves.

Pharmacokinetics

Like all external agents, heparin ointment works only with shallow layers of the dermis, subcutaneous tissue, but its pharmacokinetics have their own characteristics. Topical application of gel or ointment is provided for many diseases associated with the state of the vascular system and blood composition, therefore heparin in the form of an external agent is able to be absorbed deeper and penetrate into the systemic bloodstream. The maximum amount of heparin in the blood plasma is observed 6-8 hours after application, normalization of rheological parameters is possible after 24 hours. However, such indicators are not dangerous, since heparin has a large molecular weight and is not able to significantly disrupt the functioning of internal organs and systems, especially if it is used as an ointment or gel. In addition, a positive characteristic of heparin ointment can be considered its relative safety in the treatment of various problems with blood vessels and soft tissues during pregnancy, heparin molecules do not overcome the placental barrier and are not able to disrupt the development of the fetus.

Pharmacokinetics of heparin ointment:

• Quite rapid absorption without disruption of internal organ functions.
• Neutralization by serotonin when it enters the bloodstream after 4-6 hours.
• Formation of complexes with plasma proteins.
• Adsorption of protein complexes in the liver.
• Excretion in the form of uroheparin is via the kidneys with urine.

External medicines with heparin

Currently, the pharmaceutical industry produces many external agents containing the same active ingredient - heparin. Almost all of them are identical in composition, the difference may only be in the form, weight or concentration of the main active ingredient.

Forms of heparin as an external agent:

• Heparin ointment.
• Heparin gel.
• Gel - aerosol.

External preparations with heparin are most often used for soft tissue bruises:

1. Heparin ointment is a combination product containing sodium heparin, benzocaine, and Benzonicotinic acid.
2. Hepatotrombin, which contains Heparin sodium, Allantoin, and dexpanthenol.
3. Thrombofob - 100 grams of ointment contains 5000 U of Heparin sodium, 250 milligrams of benzyl nicotinate (benzyl ester of nicotinic acid).
4. Lioton-1000, in addition to heparin, the gel includes methyl parahydroxybenzoate, carbomer, ethanol, propyl parahydroxybenzoate, orange blossom essential oil, triethanolamine, lavender oil.

For convenience, we offer the following table, which briefly describes the most effective external preparations containing heparin:

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How is it applied?

Most often, bruises are treated with a gel form; the drug is absorbed faster and has a positive effect on the injured areas.

Method of application and dosage of heparin ointment for bruises:

• The gel or ointment is used as an external medicine.
• The skin must be intact and undamaged. Any scratch or cut is a contraindication to applying the preparation.
• The gel or ointment is applied in a small strip up to 10 cm long to the injured area.
• The dosage of the drug is 0.5-1 gram per 3-4 centimeters of the damaged area.
• The product should be applied with light rubbing movements.
• Heparin gel is applied up to 4 times a day.
• Heparin ointment is used no more than 3 times a day.
• The course of treatment for bruises should not exceed 10 days.
• If after using the drug for 7 days the symptoms do not disappear, you should consult a doctor to prescribe another more effective remedy or for additional diagnostics of the injury and detection of a hidden disease, damage to soft tissues.

Use during pregnancy

Before discussing the use of heparin ointment for bruises during pregnancy, it is necessary to determine for what purpose this remedy can in principle be used during the gestation period:

1. It is no secret that throughout pregnancy a woman's weight changes in one way or another, and the load on the cardiovascular system increases significantly, and therefore on the venous system too. Varicose veins, which temporarily lose their ability to contract, are a typical phenomenon for pregnant women. Thrombosis is not just a cosmetic defect, but also a dangerous phenomenon for the entire body of the expectant mother. Complications that are possible with thrombosis are associated with detached blood clots, emboli, and blockage of important blood channels. Heparin ointment helps prevent these conditions.
2. Another delicate problem during pregnancy is hemorrhoids, which can develop against the background of digestive disorders, constipation due to the action of progesterone. Pressure on the venous system of the rectum leads to the formation of hemorrhoids, their strangulation. These phenomena are also stopped by heparin ointment.
3. Stretch marks or stretch marks due to rupture of collagen fibers can also be prevented with topical agents containing heparin.
4. Soft tissue bruises. Heparin ointment is probably the only relatively safe remedy that helps a pregnant woman to quickly relieve swelling at the site of injury, stop the development of hematoma and accelerate the regeneration of damaged subcutaneous tissue.

Contraindications for the use of heparin ointment during pregnancy are due to individual intolerance to the main active substance, which is quite rare. Also, the ointment should not be applied to irritated skin or wounds, scratches, cuts. It is strictly forbidden to use heparin in any form with a low level of blood clotting. In general, the product is considered a fairly effective way to help pregnant women get rid of not only the symptoms of varicose veins, but also all types of closed injuries - bruises, sprains, tendons. During lactation, heparin ointment can also be prescribed, but it should be applied for no more than 5 days. Medical supervision is very important, since heparin in the form of external drugs is more actively absorbed than other ointments, and the body of an expectant or nursing mother is extremely vulnerable and unstable, self-medication can lead to unwanted side effects.

Contraindications for use

Parenteral administration of heparin has many contraindications. External application of a heparin-containing agent is the safest due to its slower absorption and the inability of active substances to affect the main functions of the body's organs and systems.

Heparin ointment, contraindications for use:

• Any irritations, cuts, wounds on the skin.
• Ulcerative-necrotic formations in the area of the contusion or in the area of thrombophlebitis.
• Hypersensitivity to the components of the ointment, gel.
• Use with caution in case of blood clotting disorders or history of increased bleeding.
• Thrombocypenia.
• Do not use on mucous membranes.
• Purulent wounds, abscesses.
• During gestation and breastfeeding, heparin ointment is used under strict medical supervision.
• Trophic ulcers.
• Increased permeability of the vascular system.
• Anemia.
• Necrosis of hemorrhoids.
• Extensive hematomas.
• Hemorrhagic diathesis.

Heparin gel or ointment has an effective effect on the blood clotting process, therefore, despite the popularity and effectiveness of this product, the ointment should be used with caution. Given the good absorption capacity of the drug and its effect on reducing local immunity (anti-inflammatory effect), when applied to damaged skin, there is a risk of infection and related complications. In addition, heparin is a strong antiproliferative component, any wound, scratch when using it will heal very slowly and with difficulty, this applies to bruises of soft tissues, accompanied by damage and suppuration of the skin. If the patient has a history of diseases associated with thrombocytopenia, blood clotting disorder (bleeding), heparin ointment applied to the hematoma can only activate internal subcutaneous hemorrhage. Indications or contraindications for the use of external agents with heparin are indicated in the instructions, but it is more advisable for the ointment to be prescribed by a doctor after examining the injury and assessing the general condition of the patient.

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Side effects

Heparin ointment is considered one of the safe and effective anticoagulants used as an external treatment for bruises, diseases associated with blood clotting disorders - thrombus formation. However, heparin is an active, high-molecular component, the properties of which should be taken into account in order to prevent complications.

Side effects of heparin ointment for bruises may be as follows:

• Increased subcutaneous bleeding with thrombocytopenia and other disorders in the hematopoietic system.
• Local allergic reaction.
• Hives, swelling, itching.
• Dermatitis.
• Infection may occur if the ointment is applied to damaged skin (wounds, cuts).

In general, when the drug is used correctly, side effects are extremely rare; heparin ointment is currently available in pharmacies as an over-the-counter drug.

Overdose

Overdose when using heparin ointment may be associated with overzealous application, when the drug is applied frequently, in a thick layer or to large areas of the body. Due to good absorption, heparin ointment or gel quickly reaches the site of damage to small vessels and can cause a reverse reaction - not a decrease in swelling and relief of hematoma, but, on the contrary, the development of edema, hyperemia of the skin and an increase in the hemorrhage zone. In addition, a thick layer of the drug creates a kind of film under which various negative reactions can develop, including allergic reactions. If atypical signs appear when applying the ointment, you should immediately stop using the drug and consult a doctor for an adequate replacement of the anticoagulant.

The ointment should be applied with special caution to those people who have at least one case of allergy in their medical history. Heparin as a high-molecular component is a fairly active substance that suppresses the resistance of local immunity, which can provoke the appearance of urticaria, itching, dermatoses. Before using the ointment, it is advisable to test it on a small area of skin, if a hypersensitive reaction does not appear within 12 hours, heparin ointment can be used according to the doctor's recommendations or according to the description of the method in the instructions.

Interactions with other drugs

Heparin ointment is not used in combination with external medications containing NSAIDs (non-steroidal anti-inflammatory drugs), and the ointment is also not combined with drugs that contain tetracycline or antihistamine components.

Interaction with other drugs is determined not only by the pharmacochemical properties of the active substances, but also by pharmacodynamics, the specific absorption of heparin ointment. For example, external use of heparin gel and simultaneous administration of oral anticoagulants can lead to a change in the prothrombin index. Interaction with other drugs also occurs - non-steroidal anti-inflammatory drugs, antiplatelet agents in both tablet and injection form.

The activity of heparin as the main active ingredient in the form of an ointment or gel can be reduced by external or tablet preparations containing tetracycline, nicotine, thyroxine, and ergot alkaloids.

As a rule, heparin-containing products for bruises are used in the first 3-5 days after the injury; if it becomes necessary to simultaneously apply an ointment with NSAIDs to the damaged area, heparin ointment is alternated with these drugs, the interval is 4-6 hours.

How is it stored?

Heparin ointment is stored according to the standards and rules described in the technical documentation and accepted in almost all pharmacies in the world. Storage conditions do not change even if the ointment is purchased and used at home. The drug should be stored in a place protected from direct sunlight at a temperature not exceeding +15 degrees Celsius. The gel form of heparin is greatly affected by environmental factors that can affect the activity and quality of the drug. Too low a temperature, as well as high, leads to the gel or ointment stratifying and losing its properties. Therefore, external medications containing heparin should be stored in a dry place, not in the refrigerator, preferably in a special first aid kit, in an area inaccessible to children. If all the rules are followed, heparin ointment retains all its pharmacochemical characteristics until the expiration date.

Best before date

The expiration date of heparin ointment is indicated on the factory packaging, as a rule, it does not exceed 3 years. After the expiration date indicated by the manufacturer as the final date of sale, the ointment or gel should be disposed of.

Heparin ointment as an effective anticoagulant is very widely used to treat many vascular diseases associated with increased thrombus formation, which often develops with bruises. Depending on the severity of soft tissue damage, an ointment or gel form is used, the latter is considered the most effective, since the gel is a dispersed system that can quickly penetrate the subcutaneous tissue. The choice of analogues of heparin ointment is large, therefore, with timely use of an anticoagulant, the symptoms of a bruise are treated within 3-5 days.

Products containing heparin or its analogues, substances with similar pharmacodynamics

Name of the drug	Form	Manufacturer
Heparin ointment	Ointment - in a 25g tube, 1g - 100 IU of heparin	Different countries
Lyoton 1000	Gel – 50g tube, 1000 units per 1g	Italy Menarini
Lyoton 1000	Gel - in a tube of 30g	Italy Menarini
Lyoton 1000	Gel – in a tube 100g	Italy Menarini
Trombless	Gel - in a 50g tube	Russia
Trombless	Gel, in a tube - 30g	Russia
Hepatrombin	Gel – 40g, options – 300 or 500IU heparin	Serbia HEMOFARM
Heparoid Zentiva	Ointment, in a tube 30g	Czech Republic Zentiva