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June 6, 1977

Continuous vs Intermittent Heparin Therapy

Author Affiliations

The Reading Hospital and Medical Center West Reading, Pa

JAMA. 1977;237(23):2469. doi:10.1001/jama.1977.03270500021002

To the Editor.—  I am concerned by two items in the article by Glazier and Crow (236:1365,1976). They document a 331/3% incidence of serious hemorrhage in patients receiving intermittent intravenous heparin sodium therapy. I regard that as an unusually and indeed unnecessarily high level of hemorrhage for this technique. I believe that the explanation for this stems from the fact that their patients who were bleeding were being given dosages of heparin sodium that averaged greater than 9,000 units every six hours. The average age of these bleeding patients was 67 years.The second item that concerns me is the 5% incidence of pulmonary embolism in the patients treated with continuous heparin therapy.It has been my experience in a very large group of patients treated with 5,000 units of heparin every six hours that major hemorrhage is an exceedingly rare event, regardless of the results of their clotting studies;