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Heparin in Pneumonia

Here is an interesting note from Betty Ciesla, MS, MT (ASCP) SH, my colleague fromMorgan State University, Baltimore, MD, a frequent contributor to Medlab_L, and author of Hematology in Practice:

Hi George. My mom age 85 was recently hospitalized for pneumonia. Although she was on IVs she was mobile for 3 days. They gave her a shot of heparin in the belly and when I questioned this, they called it standard protocol and DVT preventive. Needless to say I was pretty shocked. Is this really SOP, with no thought to heparin sensitization and HIT?

Hi, Betty, thanks for your question and it is good to hear from you. I generally avoid making judgments about medical treatments, since it is impossible to know the whole story from a distance, however I’m on pretty solid ground when I say that your mom’s physician is enlightened and that she seems to be getting proper treatment.

First, it is safe to assume that what she really got was low molecular weight heparin (LMWH), or Lovenox. Many experienced physicians and nurses just refer to Lovenox as heparin, though it is not the old standard unfractionated heparin (UFH) that is used for coronary artery bypass graft surgery. Lovenox is standard therapy for prevention, is relatively safe as it takes a large overdose to cause bleeding, and it causes HIT at a rate about 1% of UFH, probably lower at prophylactic doses.

We most often associate Lovenox with followup to surgery, especially orthopedic surgery, but it is also recommended for serious medical conditions. The reference is Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism. American College of Chest Physicians Evidence-Based Clinical Practice Guideline (8th Edition). Chest 2008; 133:381-453S. There are two statements that apply:

“For patients admitted to a critical care unit, we recommend routine assessment for VTE risk and routine thromboprophylaxis in most (Grade 1A).”

“For critical care patients who are at moderate risk for VTE (eg. medically ill or postoperative general surgery patients), we recommend using LMWH or LDUH thromboprophylaxis (Grade 1A).”

Most physicians use the ACCP Clinical Practice Guidelines as standard of care, so it appears your mom’s physicians are in compliance. Geo.

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