Complications of heparin therapy：a contemporary clinical approach to prevention and treatment        HUANG Xin-tian. Department of Vascular Surgery, Shanghai Ninth People’s Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Abstract    Anticoagulation with heparin has been proven effective for the prevention and treatment of most thromboembolic diseases. The most common complication of heparin therapy is hemorrhage, which may vary from mild mucosal oozing or hematuria to extensive intracranial, gastrointestinal, retroperitoneal, or urinary bleeding. There is a 6%-10% risk of bleeding complications when anticoagulation is in the therapeutic range. The incidence of hemorrhage may approach 50% in patients with renal failure, underlying hemostatic defects, or thrombocytopenia. Hemorrhage that is not life-threatening is best managed by discontinuation of heparin therapy. If bleeding continues, heparin may be neutralized with protamine sulfate. Heparin induced thrombocytopenia (HIT) in addition to bleeding complications is the most serious and dangerous side effect of heparin therapy. If HIT is likely, heparin must be immediately discontinued in the any form, even in absence of certain diagnosis of HIT, followed by pharmacologic inhibition with thrombin.