What are the disadvantages of unfractionated heparin (UFH) for deep venous thrombosis (DVT) prophylaxis in patients undergoing orthopedic surgery?

Updated: Jul 25, 2019
  • Author: David A Forsh, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

Answer

Disadvantages of UFH therapy include the following:

  • Variable pharmacokinetics
  • Requirement for aPTT monitoring for adjusted-dose regimens
  • Short half-life and low bioavailability
  • Lack of an oral dosage form (though an oral form has been included in clinical trials)

In addition, a small percentage of patients (2-4%) are susceptible to the development of heparin-induced thrombocytopenia (HIT), which is an antibody-mediated adverse reaction that can cause venous and arterial thrombosis. HIT is heralded by an otherwise unexpected fall in platelet count of greater than 50% from previous levels. HIT can result in disseminated intravascular coagulation (DIC) and gangrene in severe cases. Treatment with danaparoid sodium or recombinant hirudin, such as lepirudin, may be effective in life-threatening cases.

A comparison study by McGarry et al of outcomes of thromboprophylaxis between an LMWH (enoxaparin) and UFH revealed a 74% lower incidence of VTE in the LMWH group. [28] No significant difference in side effects, deaths in the hospital, or economics was noted.


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