Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;52(1):331-337.
doi: 10.1007/s11239-020-02294-2. Epub 2020 Oct 2.

Incidence and risk factors for PTT prolongation in patients receiving low-dose unfractionated heparin thromboprophylaxis

David Feinbloom  1   2 , Jason A Freed  3   4 , Alexander Carbo  5   4 , Yoojin Jung  5 , May Adra  6   4 , Shoshana J Herzig  5   4
Affiliations

Incidence and risk factors for PTT prolongation in patients receiving low-dose unfractionated heparin thromboprophylaxis

David Feinbloom et al. J Thromb Thrombolysis. 2021 Jul.

Abstract

Low-dose unfractionated heparin (LDUH) prophylaxis decreases the incidence of venous thromboembolism (VTE) in hospitalized patients, but increases the risk of bleeding events. Patients who develop a prolonged activated partial thromboplastin time (aPTT) while on LDUH may be at higher risk for bleeding complications. To determine the incidence and risk factors for aPTT prolongation in hospitalized patients receiving LDUH thromboprophylaxis, we performed a retrospective pharmacoepidemiologic cohort study of adult patients admitted to an academic medical center from September 2013 through September 2015. Among 3857 patients with at least one aPTT checked within 24 h of LDUH administration, aPTT prolongation > 1.5 times the upper limit of normal occurred in 131 (3.4%). Age 68-78 years (OR 1.6, 95% CI 1.01-2.4), age > 78 years (OR 1.9, 95% CI 1.3-2.9), female gender (OR 1.9, 95% CI 1.4-2.5), black race (OR 1.6, 95% CI 1.1-2.3), low BMI (OR 1.8, 95% CI 1.3-2.5), being admitted to a surgical service (OR 0.5, 95% CI 0.3-0.8), and receipt of high-dose (> 10,000 units in a day) unfractionated heparin prophylaxis (OR 1.4, 95% CI 1.003-2.0), were independently associated with aPTT prolongation after LDUH exposure. LDUH VTE prophylaxis is associated with aPTT prolongation in 3.4% of general hospitalized patients. We demonstrated several factors independently associated with aPTT prolongation. Monitoring aPTT levels may be indicated for select patients on LDUH thromboprophylaxis who are at high risk or consequence of bleeding and for aPTT prolongation.

Keywords: Anticoagulants; Hemorrhage; Heparin; Partial thromboplastin time; Venous thromboembolism.

PubMed Disclaimer

References

    1. Alikhan R, Bedenis R, Cohen AT (2014) Heparin for the prevention of venous thromboembolism in acutely ill medical patients (excluding stroke and myocardial infarction). Cochr Database Syst Rev 5:CD003747. https://doi.org/10.1002/14651858.CD003747.pub4 - DOI
    1. Leonardi MJ, McGory ML, Ko CY (2006) The rate of bleeding complications after pharmacologic deep venous thrombosis prophylaxis: a systematic review of 33 randomized controlled trials. Arch Surg 141(8):790–797. https://doi.org/10.1001/archsurg.141.8.790 discussion 797-799 - DOI
    1. Lederle FA, Zylla D, MacDonald R, Wilt TJ (2011) Venous thromboembolism prophylaxis in hospitalized medical patients and those with stroke: a background review for an American college of physicians clinical practice guideline. Ann Intern Med 155(9):602–615. https://doi.org/10.7326/0003-4819-155-9-201111010-00008 - DOI
    1. Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH, American College of Chest P (2012) Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e195S–226S. https://doi.org/10.1378/chest.11-2296 - DOI
    1. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM (2012) Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl):e227S–277S. https://doi.org/10.1378/chest.11-2297 - DOI

LinkOut - more resources