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February 21, 1977

Heparin Prophylaxis

JAMA. 1977;237(8):768. doi:10.1001/jama.1977.03270350028014

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To the Editor.—  I was pleased to read Dr Wessler's timely article on heparin sodium (236:389, 1976). We have had substantial experience in the use of the 5,000 units every eight hours regimen. This dose has been extremely well tolerated with several exceptions.It is our clinical impression that women more than 60 or 65 years of age tend to bleed somewhat more with this dose than one might have anticipated. We have advised using one half to three fourths of the usual dose in these patients and have empirically recommended 3,000 units three times per day. Second, women weighing less than 45 kg seem to bleed more than normal. A third group of patients in whom we definitely have seen bleeding problems is adults with bilateral above-the-knee amputations. I think the problem here is that one tends to forget how much tissue-mass has been removed from such patients.We