Heparin prophylaxis

Pineo, G. and Hull, R. 1997. Low molecular weight heparin-prophylaxis and treatment of venous thromboembolism. Annual Review of Medicine 48, 79-91. 

Small subcutaneous closes of heparin have been found to be effective in high-nsk post-surgical patients and in patients with acute myocardial infarction. The preventive treatment is commenced a few hours before an operative procedure and continued postoperatively for 4 to 5 days. As the result of a study in 1975. low-dose heparin prophylaxis in high-nsk patients who undergo abdomina-thoracic surgery has become a widely accepted practice, However, preventive anticoagulant therapy, to date, has been unsatisfactory and controversial in the instances of hip surgery or prostatectomy. 

Hull RD, Brant RF, Pineo GF, et al. Preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement. Arch Intern Med 1999 159 137-141. 

Johnson RN, Balyeat E, Stern WH. Heparin prophylaxis for intraocular fibrin. Ophthalmology 1987 94 597-601. 

The effect of low-molecular-weight heparin on bone mineral density has been assessed in a multicenter multinational randomized study in pregnant women with thrombophilia [118 ]. There was no significant difference in mean bone mineral density between those who were given low-molecular-weight heparin prophylaxis and those who were given no prophylaxis, but the study was not adequately powered to detect differences in the absolute risk of fractmes. 

Aspirin should be started within 48 hours of stroke onset and may be used safely in combination with low doses of subcutaneous heparin for DVT prophylaxis. 

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... 

Prophylaxis -can be used in heparin-induced thrombocytopenia Lepirudin 0.1 mg/kg/hr... 

Heparins for DVT prophylaxis Bleeding platelets Bleeding daily, platelets if suspected thrombocytopenia... 

Either low-dose unfractionated heparin or low-molecular weight heparin are effective A in preventing deep vein thrombosis Stress ulcer prophylaxis... 

Heparin, which has an anticoagulation action, may give rise to heparin-induced thrombocytopenia, which is an immune-mediated condition that usually develops 5-10 days after the administration of the drug. When heparin is used, a platelet count should be measured before treatment and if administration is repeated, platelet counts should be monitored regularly. Signs of thrombocytopenia include a reduction in platelet count. It may present with spontaneous haemorrhage and heparin should be stopped. Factor VIII is used in the treatment and prophylaxis of haemorrhage in patients with haemophilia. 

Thrombosis, prophylaxis or treatment As an anticoagulant for prophylaxis or treatment of thrombosis in heparin-induced thrombocytopenia (HIT). 

Since arterial emboli formation involves platelet aggregation and leukocyte and erythrocyte inhltration into the fibrin network, the treatment and prophylaxis of arterial thrombi are more difficult. Arterial embolism is treated more successfully with heparin than with the oral anticoagulants. Anticoagulants are useful for prevention of systemic emboli resulting from valvular disease (rheumatic heart disease) and from valve replacement. 

Primary prevention of venous thrombosis reduces the incidence of and mortality rate from pulmonary emboli. Heparin and warfarin may be used to prevent venous thrombosis. Subcutaneous administration of low-dose unfractionated heparin, low-molecular-weight heparin, or fondaparinux provides effective prophylaxis. Warfarin is also effective but requires laboratory monitoring of the prothrombin time. 

Kher A, Samama MM. Primary and secondary prophylaxis of venous thromboembolism with low-molecular-weight heparins prolonged thromboprophylaxis, an alternative to vitamin K antagonists. J Thromb Haemost. 2005 3 473-481. 

Continuous intravenous administration of heparin is accomplished via an infusion pump. After an initial bolus injection of 80-100 units/kg, a continuous infusion of about 15-22 units/kg/h is required to maintain the aPTT at 2-2.5 times control. Patients with acute pulmonary emboli often require larger doses than these during the first few days because of binding to a variety of acute phase proteins, such as factor VIII and von Willebrand factor, and increased heparin clearance. Subcutaneous administration of heparin, as in low-dose prophylaxis, is achieved with 5000 units every 8-12 hours. Because of the danger of hematoma formation at the injection site, heparin must never be administered intramuscularly. 

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