Skip to main content
SpringerLink
Log in

Monitoring Heparin Prophylaxis

  • Chapter
Prevention of Venous Thrombosis and Pulmonary Embolism

  • 71 Accesses

Abstract

The monitoring of heparin prophylaxis has long been a problem. As a result, many tests have been devised but have proved unsatisfactory for one reason or another. It was shortly before the discovery of heparin by McLean in 1916 that the Lee-White coagulation time test (1913) for blood was introduced and later used to determine the effect of heparin on coagulation. In general blood coagulation time has for many years been relied upon as the best method available. The test is performed by drawing 3 ml of venous blood in a dry glass syringe. With the needle removed, 1 ml of blood is delivered into three test tubes of standard size, 13 × 100 mm. A stopwatch is started when the blood is drawn into the syringe. The tubes are placed in a water bath at 37°C and after 2 minutes tilted every 30 seconds. When clotting is noted in each tube the times are recorded and their average is reported as the coagulation time; the normal range is 5–10 minutes. The test is not precise chiefly because of the difficulty in determining the end-point and is therefore less than satisfactory. An equally unsatisfactory and little used test is the capillary tube test where fingertip blood is allowed to fill capillary glass tubes of 1 mm diameter and 5 cm length; a stopwatch is started and the tubes are broken every 30 seconds until a fibrin thread is seen between the broken ends. The normal range is 3–5 minutes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Barrowcliffe, T. W., Johnson, E. A. and Thomas, D. P. (1978). Antithrombin III and heparin. Br. Med. Bull., 34, 143

    PubMed  CAS  Google Scholar 

  2. Basu, D., Gallus, A., Hirsh, J. and Cade, J. (1972). A prospective study of the value of monitoring heparin treatment with the activated partial thromboplastin time. N. Engl. J. Med., 287, 324

    Article  PubMed  CAS  Google Scholar 

  3. Bonnar, J. and Denson, K. W. E. (1973). Monitoring of heparin. Thromb. Diath. Haemorrh., 30, 471

    PubMed  Google Scholar 

  4. Brozovic, M. and Bangham, D. R. (1975). Heparin structure, function and clinical implications. In Bradshaw, R. A. and Wessler, S. (eds.) Advances in Experimental Medicine and Biology, Vol. 52, pp. 163–79. (New York and London: Plenum Press)

    Google Scholar 

  5. Bull, M. H., Huse, W. M. and Bull, B. S. (1975). Evaluation of tests used to monitor heparin therapy during extracorporeal circulation. Anaesthesiology, 43, 346

    Article  CAS  Google Scholar 

  6. Charnley, J. (1972). Prophylaxis of postoperative thromboembolism. Lancet, 2, 134

    Article  PubMed  CAS  Google Scholar 

  7. Cooke, E. D., Lloyd, M. J., Bowcock, S. A. and Pilcher, M. F. (1976). Monitoring during low-dose heparin prophylaxis. N. Engl. J. Med., 294, 1066

    PubMed  CAS  Google Scholar 

  8. Davis, J. J. (1975). Monitoring during low dose heparin prophylaxis. N. Engl. J. Med., 293, 776

    PubMed  CAS  Google Scholar 

  9. Denson, K. W. E. and Bonnar, J. (1973). The measurement of heparin. A method based on the potentiation of antifactor Xa. Thromb. Diath. Haemorrh., 30, 471

    PubMed  CAS  Google Scholar 

  10. deTakats, G. (1943). Heparin tolerance, a test of the clotting mechanism. Surg. Gynecol. Obstet., 77, 31

    Google Scholar 

  11. deTakats, G. (1971). Heparin tolerance revisited. Surgery, 70, 318

    CAS  Google Scholar 

  12. deTakats, G. (1977). Small-dose prophylactic heparin, does it prevent venous thrombosis? Mod. Med., 38

    Google Scholar 

  13. Genton, E. (1974). Guidelines for heparin therapy. Ann. Intern. Med., 89, 77

    Google Scholar 

  14. Gormsen, J. and Haxholdt, B. Fl. (1960). The heparin tolerance test and thromboembolic incidence in surgery. Acta Chir. Scand., 120, 121

    PubMed  CAS  Google Scholar 

  15. Gruber, V. F., Duckert, F., Fridrich, R., Torhorst, J. and Rem, J. (1977). Prevention of postoperative thromboembolism by dextran 40, low doses of heparin and xantinol nicotinate. Lancet, 1, 207

    Article  PubMed  CAS  Google Scholar 

  16. Kazmier, F. J. (1976). A significant interaction between metronidazole and warfarin. Mayo Clin. Proc., 5, 782

    Google Scholar 

  17. Koepke, J. A. (1975). The partial thromboplastin time in the C. A. P. survey program. Am. J. Clin. Pathol., 63, 990

    PubMed  CAS  Google Scholar 

  18. Makarg, A. L. and Waterbury, V. (1977). The activated partial thromboplastin time as a monitor of heparin: a warning. Johns Hopkins Med. J., 140, 311

    Google Scholar 

  19. Mant, M. J., O’Brien, B. D., Thong, K. L., Hammond, G. W., Birtwhistle, R. V. and Grace, M. G. (1977). Hemorrhagic complications of heparin therapy. Lancet, 1, 1133

    Article  PubMed  CAS  Google Scholar 

  20. Multicentre Trial (1975). Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Lancet, 2, 45

    Google Scholar 

  21. Pachter, H. L. and Riles, T. S. (1977). Bleeding and wound complications in the surgical patient, a prospective randomized study. Ann. Surg., 186, 669

    Article  PubMed  CAS  Google Scholar 

  22. Penner, J. A. (1974). Experience with a thrombin clotting time assay for measuring heparin activity. Am. J. Clin. Pathol., 61, 645

    PubMed  CAS  Google Scholar 

  23. Poller, L., Thomson, J. H. and Yee, K. F. (1977). Stability studies on lyophilized reference thromboplastins for standardization of prothrombin times. Lancet, 2, 1019

    Article  PubMed  CAS  Google Scholar 

  24. Prevention of venous thromboembolism in surgical patients by low dose heparin. (1977). Circulation, 55, 423A

    Google Scholar 

  25. Shapiro, G. A., Huntzinger, S. W. and Wilson, J. E. (1977). Variation among commercial activated partial thromboplastin time reagents in response to heparin. Am. J. Clin. Pathol., 67, 477

    PubMed  CAS  Google Scholar 

  26. Sharnoff, J. G. (1963). An evaluation of the Dale and Laidlaw coagulometer in heparin control of thromboembolism. NY State Assoc. Pub. Hlth. Lab., 43, 10

    Google Scholar 

  27. Sharnoff, J. G. (1977). Low-dose or small-dose heparin. Lancet, 2, 1087

    Article  PubMed  CAS  Google Scholar 

  28. String, S. T. and Barcia, P. J. (1975). Complications of small dose prophylactic heparinization. Am. J. Surg., 130, 570

    Article  PubMed  CAS  Google Scholar 

  29. Sherry, S. (1971). Thrombosis prevention. N. Engl. J. Med., 284, 1324

    Article  PubMed  CAS  Google Scholar 

  30. Soloway, H. B., Cornett, B. M. and Grayson, J. W. (1972). Comparison of various activated partial thrombo-reagents in the laboratory control of heparin therapy. Am. J. Clin. Pathol., 39, 587

    Google Scholar 

  31. Taberner, D. A., Poller, L., Burslem, R. W. and Jones, J. B. (1978). Oral anticoagulants controlled by the British comparative thromboplastin versus low-dose heparin in prophylaxis of deep vein thrombosis. Br. Med. J., 1, 272

    Article  PubMed  CAS  Google Scholar 

  32. Teien, A. N. and Lie, M. (1975). Heparin assay in plasma. A comparison of five clotting methods. Thromb. Res., 7, 777

    Article  PubMed  CAS  Google Scholar 

  33. Teien, A. N., Lie, M. and Abildgard, U. (1976). Assay of heparin in plasma using a chromagenic substance for activated factor X. Thromb. Res., 8, 413

    Article  PubMed  CAS  Google Scholar 

  34. Thomas, D. P. (1977). Low-dose heparin. Lancet, 2, 1181

    Article  PubMed  CAS  Google Scholar 

  35. Triplett, D. A., Harms, G. J. and Koepke, J. A. (1978). The effect of heparin in activated partial thromboplastin times. Am. J. Clin. Pathol., 70, 556

    PubMed  CAS  Google Scholar 

  36. Wessler, S. and Gitel, S. (1976). Control of heparin therapy. Prog. Hemostas. Thromb., 3, 311

    CAS  Google Scholar 

  37. Yin, E. T., Wessler, S. and Butler, J. V. (1973). Plasma heparin, a unique practical submicrogram-sensitive assay. J. Lab. Clin. Med., 8, 298

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Mount Vernon Hospital, Mount Vernon, New York, USA

    J. G. Sharnoff (Pathologist and Director of Laboratories)

Authors
  1. J. G. Sharnoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 1980 J. G. Sharnoff

About this chapter

Cite this chapter

Sharnoff, J.G. (1980). Monitoring Heparin Prophylaxis. In: Prevention of Venous Thrombosis and Pulmonary Embolism. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-8703-6_11

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-8703-6_11

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-009-8705-0

  • Online ISBN: 978-94-009-8703-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation