Managing the hemorrhagic complications of heparin therapy

Heparin provides a powerful therapeutic ally for the clinician challenged by patients with thromboembolic disorders. A wide range of complications, however, has been observed in patients receiving heparin for thromboembolic disorders considered to be serious or life-threatening. This article addresses the management of heparin-associated bleeding. In doing so, the author examines the factors affecting levels of heparin that could lead to inappropriate or excessive administration--namely, heparin metabolism, heparin administration, laboratory monitoring, and a major contributing complication, heparin-induced thrombocytopenia. Unfortunately, attempts to manage anti-coagulant bleeding in the presence of thrombosis can often create additional difficulties that continue to challenge the clinician.