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Heparin Dose Adjustment in Trauma Patients - Application, Procedure, and Side Effects

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Heparin is a blood thinner. Read below to learn how it can reduce patient severity in post-trauma cases.

Medically reviewed by

Dr. Abdul Aziz Khan

Published At February 24, 2023
Reviewed AtDecember 1, 2023


Heparin belongs to a class of drugs known as anticoagulants (which help prevent blood clots). These are also known as "blood thinners." Heparin is a naturally occurring glycosaminoglycan (a type of polysaccharide). Heparin is used to prevent the formation of blood clots in individuals with certain medical disorders, like patients after trauma or those who need to undergo specific medical procedures. It prevents the formation of blood clots but does not reduce the size of existing clots. Small doses of heparin are also used to prevent the formation of blood clots in catheters (tiny plastic tubes used to collect blood or deliver medication and left in veins for longer periods). Heparin prevents or treats pulmonary embolism (PE) or deep vein thrombosis (DVT) in trauma patients.

What Are Deep Vein Thrombosis and Pulmonary Embolism?

Thromboses are blood clots that form in the blood due to their components, while an embolism is a detached thrombus. In post-trauma patients, a blood clot (thrombus) forms in one or more deep veins in the body, generally in the legs, and causes deep vein thrombosis (DVT). Leg pain or edema may occur due to deep vein thrombosis. But in some cases, the patient does not show any apparent signs. Deep vein thrombosis can be dangerous because blood clots in the veins can get detached. After that, the clots may move through the bloodstream and become lodged in the lungs, obstructing blood flow (pulmonary embolism). A person who has experienced trauma is at greater risk of developing these thromboembolic disorders.

What Are the Applications of Heparin?

Apart from use in deep vein thrombosis and pulmonary embolism, heparin is used in the following:

  • Acute Arterial Embolism - When blood clots form in the arteries, heparin is used in treatment.

  • Thrombophlebitis - Inflammatory condition of blood vessels leading to clot formation in the blood.

  • Clot Prevention - Prevents clotting in a patient undergoing hemodialysis. Open heart surgery, bypass surgery, renal dialysis, and blood transfusions also use heparin to stop blood clotting.

  • Prophylactic Treatment - It is prescribed to some patients to avoid blood clot development, particularly in those who must undergo surgery or spend a lot of time in bed. Heparin is occasionally administered alone or with aspirin to avoid miscarriage and other issues in pregnant women with specific medical conditions.

  • Diagnostic and Treatment Agent - Disseminated intravascular coagulation is a dangerous blood disorder in which blood clots form in the whole body. In this condition, heparin may also be used in diagnosis and treatment.

How Can Venous Thromboembolism (VTE) In Trauma Patients Be Prevented?

  • All trauma patients should receive VTE prophylaxis with heparin within twenty-four hours of admission.

  • VTE prophylaxis of heparin should not be given to an individual with liver problems.

  • Heparin should not be given for operative procedures except in spine and neurosurgical operative cases.

How Is Heparin Used in VTE Prophylaxis (Prevention) Protocol for Traumatic Brain and Spinal Cord Injury?

VTE prophylaxis with heparin should start within 72 hours of the injury. Prophylactic treatment with heparin should start within 24 hours after admission in the case of a person with the following:

  • Mild traumatic brain injury (TBI).

  • Blood collection in the brain, also known as a subdural or epidural hematoma less than five millimeters.

  • Bleeding in the brain, known as contusion or intraventricular hemorrhage less than two centimeters.

  • A repeat CT scan (computed tomography scan) demonstrates stability.

  • VTE prophylaxis of heparin should start within 24 hours for patients with minimal TBI.

  • Patients with intraspinal hematomas (bleeding from the spinal cord) should begin VTE prophylaxis within 48 hours of arrival at the hospital if there are no specific instructions from the surgical team.

  • For spinal surgery patients, VTE prophylaxis should be started on the morning of the day of surgery or 24 hours after the surgery unless the surgical team is instructed to the contrary.

How Do Doctors Infuse Heparin?

Heparin is given intravenously (infused through the vein). Therefore, a blood test needs to ensure the individual is adequately medicated with heparin (the dosage is adequate and not low or more than required) in the blood. In addition, a test known as the partial thromboplastin time is used to determine how effectively the drug works. The partial thromboplastin time (PTT) test determines how long the blood can clot. Doctors will modify the heparin dosage based on the subsequent results of PTT tests to ensure the effectiveness of heparin.

How Is the Safety of Heparin Assessed?

To ensure the patient’s safety, doctors perform specific tests. These assessments look at the following:

  • Clinical Observation: A doctor will track how well a person responds to heparin by performing coagulation or clotting tests. The outcomes of these tests will also assist a doctor in determining the ideal heparin dosage for an individual.

  • Kidney Assessment: A person has more tendency to bleed if the kidneys of a person are not functioning correctly. A doctor will monitor kidney function to ensure a person can safely take this medication.

  • Liver Performance: A person may experience an increased risk of bleeding if the liver is not functioning well. A doctor will check the liver properly to ensure the safety of the medication.

  • Indicators of Hemorrhage: A doctor will check platelet and hematocrit levels (hemoglobin). In addition, specific tests detect the presence of blood in the stool. This test ensures that a person is not bleeding internally while using this medication.

What Are the Side Effects of Heparin?

Heparin causes the following side effects:

  • In some cases, it causes extreme bleeding.

  • People become more prone to bruising.

  • Excess bleeding in the gum.

  • Severe nosebleeds.

  • Menstrual bleeding becomes heavier-than-usual cycles.

  • Brown or pink urine.

  • Tarry, dark stool (may be a sign of bleeding in the stomach).

  • Coughing with blood or blood clots.

  • Vomit that contains blood.

  • Headaches.

  • Weakness.

  • Dizziness.

What Are the Signs and Symptoms of Heparin Allergy?

Severe allergic responses are also seen in some patients, such as:

  • Necrosis (dead) skin tissue at the injection site.

  • Chills.

  • Fever.

  • Hives and a rash.

  • Itching.

  • Burning.

  • Breathing difficulty.

  • Swelling of tongue, throat, lips, or face.


Heparin is a drug with anticoagulant properties. It is given intravenously. It prevents blood clot formation. Due to its anticoagulant nature, it is given routinely in post-trauma patients as they are at a greater risk for developing blood clots and conditions such as deep vein thrombosis and pulmonary embolism. Apart from that, it is also used to treat several medical conditions.

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Dr. Abdul Aziz Khan
Dr. Abdul Aziz Khan

Medical oncology


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