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[Frequency of severe abdominal wall hemorrhage with subcutaneous anticoagulation using calcium-heparin]
1Medizinische Universitätsklinik, Inselspital Bern.
Insights
Subcutaneous calcium heparin treatment in elderly patients led to severe bleeding in four cases, with two deaths. Therapeutic doses should be used cautiously in this population due to high bleeding risk.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Hematology
Background:
- Subcutaneous heparin is commonly used for anticoagulation.
- Elderly patients may have altered drug metabolism and increased bleeding risk.
Observation:
- Four cases of severe bleeding occurred in 50 elderly patients receiving subcutaneous calcium heparin.
- Bleeding sites included the abdominal wall and retroperitoneum.
- Two patients died as a result of the bleeding.
Findings:
- Heparin doses ranged from 2x12,500 to 2x20,000 I.U/day.
- Thrombin times were subtherapeutic before heparin administration in all affected patients.
- This suggests potential issues with heparin efficacy or patient-specific factors.
Implications:
- Therapeutic doses of subcutaneous heparin in elderly patients should be reserved for exceptional circumstances.
- Close monitoring for bleeding complications is crucial in this demographic.
- Further research into heparin dosing and monitoring in the elderly is warranted.
Abstract:
Four cases of severe bleeding among 50 elderly patients undergoing subcutaneous calcium heparin treatment are reported. In three patients the bleeding was localized in the abdominal wall and the fourth in the retroperitoneum; 2 patients died. Heparin doses ranged between 2x12,500 and 2x20,000 I.U/day. The thrombin times, measured before the next administration, were in the subtherapeutic range in all patients. We conclude that in elderly patients subcutaneous heparin treatment in therapeutic doses should be reserved for exceptional cases.