When is IV unfractionated heparin (UFH) therapy preferred for anticoagulation for pulmonary embolism (PE)?

Updated: Sep 18, 2020
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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In patients with acute PE, anticoagulation with IV UFH, LMWH, or fondaparinux is preferred over no anticoagulation. [5] Most patients with acute PE should receive LMWH or fondaparinux instead of IV UFH. In patients with PE, if concerns regarding subcutaneous absorption arise, severe renal failure exists, or if thrombolytic therapy is being considered, IV UFH is the recommended form of initial anticoagulation. [5] Clinicians often choose to use IV UFH in preference to LMWH and fondaparinux in specific clinical circumstances where medical or surgical procedures are likely to be performed and the short half-life of IV UFH allows for temporary cessation of anticoagulation and presumed reduction of bleeding risk during the procedure. Though this strategy has limited supporting evidence, it appears to represent a reasonable practice.

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