What is the role of heparin in the treatment of venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Heparin is the first line of therapy. It is administered by bolus dosing, followed by a continuous infusion. Adequacy of therapy is determined by an activated partial thromboplastin time (aPTT) of 1.5-2 times baseline. Progression or recurrence of thromboembolism is 15 times more likely when a therapeutic aPTT is not achieved within the first 48 hours.

A weight-based nomogram has been employed to determine adequate dosing, using heparin at 80 mg/kg for the bolus and 18 mg/kg/hr for the infusion. A short course of heparin is followed by a longer course of oral anticoagulant (warfarin sodium). It should be started only after effective anticoagulation has been achieved; there can be an increase in coagulability and thrombogenesis during the first few days of oral anticoagulant administration.

The goal is to achieve an international normalized ratio (INR) of 2.0-3.0. The optimum duration of treatment depends on several factors (eg, first episode or recurrent event, other underlying risk factors). [35]  A minimum of 3 months of oral therapy has been suggested following a first episode of DVT or PE.


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