Bleeding with unfractionated heparin

Frequent control of coagulability is not necessary with low molecular weight heparin and incidence of side effects (bleeding, heparin-induced thrombocytopenia) is less frequent than with unfractionated heparin. 

Deep vein thrombosis prophylaxis is recommended for septic patients. Low-dose unfractionated heparin or low-molecular-weight heparin may be utilized. Graduated compression stockings or an intermittent compression device is recommended for patients with a contraindication to heparin products (thrombocytopenia, severe coagulopathy, active bleeding, or recent intracerebral hemorrhage).24... 

The recommendation for UFH is based on documented efficacy in many older mid-sized trials. Meta-analyses showed a clear reduction in Ml and death, but at the cost of an increase in major bleeding rates (35,36). The advantages of LMWH over unfractionated heparin include a better bioavailability, a stronger and longer anti-Xa activity, less platelet activation, and no need for monitoring. A major drawback of standard heparin therapy is the potential risk of heparin-induced thrombocytopenia, which is considerably reduced with LMWH (37). 

Low-dose unfractionated heparin or LMW heparin can be used to prevent venous thromboembolism in other high-risk patients, e.g. those confined to bed and immobilised with strokes, cardiac failure or malignant disease. Spontaneous bleeding has not been a problem with this form of anticoagulant treatment. 

In the absence of contraindications, the treatment of VTE initially should include a rapid-acting anticoagulant (e.g., unfractionated heparin [UFH], a low-molecular-weight heparin [LMWH], or fondaparinux) overlapped with warfarin for at least 5 days and until the patient s international normalized ratio (INR) is greater than 2.0. Anticoagulation therapy should be continued for a minimum of 3 months. The duration of anticoagulation therapy should be based on the patient s risk of VTE recurrence and major bleeding. 

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