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Life-threatening hemorrhage following subcutaneous heparin therapy

Prophylactic administration of unfractionated heparin is a common practice in a perioperative period. Heparin monitoring with subcutaneous dosing is not recommended; however it becomes important in selected patients. We report a case of massive hemorrhage with subcutaneous heparin administration in...

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Detalles Bibliográficos
Autores principales: Hudcova, Jana, Talmor, Daniel
Formato: Texto
Lenguaje:English
Publicado: Dove Medical Press 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697517/
https://www.ncbi.nlm.nih.gov/pubmed/19436612
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author Hudcova, Jana
Talmor, Daniel
author_facet Hudcova, Jana
Talmor, Daniel
author_sort Hudcova, Jana
collection PubMed
description Prophylactic administration of unfractionated heparin is a common practice in a perioperative period. Heparin monitoring with subcutaneous dosing is not recommended; however it becomes important in selected patients. We report a case of massive hemorrhage with subcutaneous heparin administration in an HIV-positive male patient with cachexia and mild liver dysfunction. Prolonged activated plasma thromboplastin time and thrombin time, but normal reptilase time well as response to protamine sulfate point towards the heparin effect. Inhibitor screen was negative and factor VIII activity was normal. All these rule out the possibility of acquired factor VIII inhibitor or any other inhibitor and confirm that this bleeding was due to heparin overdose. We believe that delayed clearance of UH secondary to possible involvement of reticuloendothelial system might have been be responsible for heparin overdose even though inadvertent administration of large dose of heparin intravenously can not be completely ruled out. Administration of unfractionated heparin to a patient with cachexia and abnormal liver function warrants close attention to heparin monitoring or switch to low molecular weight heparin since its mechanism of elimination differs.
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spelling pubmed-26975172009-06-17 Life-threatening hemorrhage following subcutaneous heparin therapy Hudcova, Jana Talmor, Daniel Ther Clin Risk Manag Case Report Prophylactic administration of unfractionated heparin is a common practice in a perioperative period. Heparin monitoring with subcutaneous dosing is not recommended; however it becomes important in selected patients. We report a case of massive hemorrhage with subcutaneous heparin administration in an HIV-positive male patient with cachexia and mild liver dysfunction. Prolonged activated plasma thromboplastin time and thrombin time, but normal reptilase time well as response to protamine sulfate point towards the heparin effect. Inhibitor screen was negative and factor VIII activity was normal. All these rule out the possibility of acquired factor VIII inhibitor or any other inhibitor and confirm that this bleeding was due to heparin overdose. We believe that delayed clearance of UH secondary to possible involvement of reticuloendothelial system might have been be responsible for heparin overdose even though inadvertent administration of large dose of heparin intravenously can not be completely ruled out. Administration of unfractionated heparin to a patient with cachexia and abnormal liver function warrants close attention to heparin monitoring or switch to low molecular weight heparin since its mechanism of elimination differs. Dove Medical Press 2009-03-26 /pmc/articles/PMC2697517/ /pubmed/19436612 Text en © 2009 Hudcova and Talmor, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Case Report
Hudcova, Jana
Talmor, Daniel
Life-threatening hemorrhage following subcutaneous heparin therapy
title Life-threatening hemorrhage following subcutaneous heparin therapy
title_full Life-threatening hemorrhage following subcutaneous heparin therapy
title_fullStr Life-threatening hemorrhage following subcutaneous heparin therapy
title_full_unstemmed Life-threatening hemorrhage following subcutaneous heparin therapy
title_short Life-threatening hemorrhage following subcutaneous heparin therapy
title_sort life-threatening hemorrhage following subcutaneous heparin therapy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697517/
https://www.ncbi.nlm.nih.gov/pubmed/19436612
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