title: Systemic effects of subcutaneous heparin use in otolaryngology patients.
abstract: OBJECTIVE
  To describe a population of otolaryngology patients who developed systemic anticoagulation from pharmacologic deep vein thrombosis prophylaxis using subcutaneous low-dose unfractionated heparin and describe associated adverse events and identify risk factors for this occurrence.
  
  
  METHODS
  Retrospective case series with chart review.
  
  
  METHODS
  Single-institution, academic tertiary care center.
  
  
  METHODS
  Patients who developed prolonged partial thromboplastin times from routine administration of subcutaneous low-dose unfractionated heparin postoperatively were retrospectively identified during a 16-month period. Data regarding demographics, disease characteristics, laboratory values, associated complications, and risk factors were collected and analyzed.
  
  
  RESULTS
  Five patients, all with head and neck cancer, postoperatively developed prolonged partial thromboplastin time levels with prophylactic subcutaneous low-dose unfractionated heparin. All had body mass index ≤ 20 kg/m(2) and received 5000 units of subcutaneous low-dose unfractionated heparin 3 times daily. Four had impaired renal function. Adverse events included 5 postoperative wound hematomas, an emergent reintubation, and a case of persistent mucosal bleeding. These bleeding complications accounted for 25% of all bleeding complications in otolaryngology patients during the same period.
  
  
  CONCLUSIONS
  Unanticipated systemic effects of subcutaneous low-dose unfractionated heparin can cause significant morbidity in surgically treated patients with head and neck cancer. From this case series, risk factors appear to include subcutaneous low-dose unfractionated heparin 3 times daily dose frequency, low body mass index, and renal dysfunction. For this at-risk patient population, a protocol is needed to minimize both deep vein thromboses and complications of prophylactic therapy.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Blank
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Grindler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Zerega
authors.affiliation: Division of Hematology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Morey
authors.initials: M
authors.lastname: Blinder
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA nussenbaumb@ent.wustl.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010314:Partial Thromboplastin Time; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D006493:Heparin
keywords: bleeding; deep venous thrombosis; heparin; pharmacologic prophylaxis; subcutaneous