The safety of low dose heparin prophylaxis

Abstract

In a recent survey, eight of ten general surgeons claimed to have a high awareness of the prophylactic use of heparin sodium in subanticoagulant doses, although the use of low dose heparin is considerably lesser. Actual use of this regimen occurs in 4 per cent of surgical patients. Surgeons are reluctant to use anticoagulant therapy in a prophylactic manner due to (1) the fear of bleeding in intra- and postoperative patients and (2) the necessity of regulating the anticoagulant therapy by means of laboratory monitoring. Heparin has recently gained prominence for prophylactic use particularly in older patients undergoing surgery and in those prone to thrombosis for other reasons [16]. The efficacy of low dose heparin in preventing fatal postoperative pulmonary embolism was investigated in the multicenter trial of Kakkar and his associates [3,4,12]. The recommendations for prophylactic use of low dose heparin on a large scale in “high risk” patients undergoing major surgery were further confirmed in our present study of thirty-two surgical patients. We have demonstrated that in a routine surgical environment heparin can be administered according to a prophylactic regimen in a manner easily understood by the staff, without the need of extensive and costly laboratory monitoring, and without bleeding that would have interfered with the surgical procedures.