To the Editor.—In response to the recent article by Ariyan and Stansel outlining the dangers associated with delayed bleeding following heparin sodium administration in three patients with vascular anastomoses, all of the treated individuals received the same dose of heparin during bolus intravenous therapy, and aside from the Lee-White clotting time determined in the second patient, adjustments in dosage according to body weight, plasma coagulation factors, platelet function, or underlying pathologic problems were not done.
Work in our laboratory over the past four years has indicated that these variables may be important in the calculation of heparin dosage.1.2 We have demonstrated the importance of platelets and platelet red blood cell interactions in the neutralization of intravenously administered heparin in the dog. In addition, unpublished data from our laboratory demonstrate the tremendous fluctuation between incoagulability and hypercoagulability of a variety of tests following bolus heparin injections in the dog.
CAPRINI JA. Hazards of Heparin Therapy. Arch Surg. 1976;111(5):615. doi:10.1001/archsurg.1976.01360230114032
* * SCHEDULED MAINTENANCE * *
The JAMA Network Sites will be conducting routine maintenance from 10/20/2017 through 10/21/2017. During this window access to content and authentication may be intermittently available. The JAMA Store will be completely unavailable during the maintenance window.