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MONITORING LOW-DOSE HEPARIN PROPHYLAXIS
... For
Low-dose heparin prophylaxis appears to be gaining acceptance and may soon become a standard in medical practice. Because much smaller doses are used in prophylaxis of thrombosis than in actual treatment of an active thrombosis, many physicians have not employed heparin monitoring procedures with low-dose therapy. Yet there have been reports that the currently a~~epterllow-dose regimens can produce varying degrees of anticoagulation in different individuals. At the peak of anticoagulation with low-dose heparin, some patients may reach a degree of anticoagulation similar to that seen with heparin therapy of active thrombosis and a few authors have reported bleeding complications. Therefore, because a small proportion of patients appear to be at risk of bleeding complications on low-dose heparin prophylaxis, it seems essential to monitor heparin at its peak effect, which is 2-3 hours after subcutaneous administration.
Davis, L.J.: New England Medical Journal293: 776 (9 Oct 1975)
... and Against
Dr. Sol Sherry disagrees with the above recommendation to monitor low-dose heparin therapy in order to prevent infrequent bleeding complications. A requirement for monitoring would reduce the number of high-risk patients placed on low-dose heparin - the occurrence of pulmonary emboli in patients denied this form of prophylaxis would far outweigh the elimination of an occasional bleeding episode. Furthermore, there is no evidence that monitoring will prevent these bieeds. Several leaders in thls area believe that monitorh1g heparin is more useful in ad>Jev:ing an adequate state of anticoagulation than in avoiding bleeding complications.
Although Dr. Sherry does not find monitoring of low-dose heparin prophylaxis desirable, he mentions several precautions to be considered in reducing the risk of the infrequent bleeding complications.
• Avoid the use of low-dose heparin in patients with known haemostatic defects of bleeding lesions. • Discontinue drugs which can alter haemostasis. • Pay careful attention to the recommendations for subcutaneous administration of heparin, including the use of a
syringe that accurately allows for injection of only 0.2ml containing 5,000 units of heparin. • Single-dose ampoules, containing 5,000 units in 0.2ml might be useful in eliminating heparin dosage errors.
Sherry, S.: New England Medical Journal 293: 776 (9 Oct 1975)
INPHARMA 18th October, 1975 p.2
