Summary
Bleeding complications occurred in 30 (11%) out of 280 patients who received continuous
heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients
(3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal
and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined
by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin
time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified
plasma [CaTT]). The differences in median heparin activity between patients with minor
bleeding and patients with no bleeding did not reach significance for any of the tests.
In patients with major bleeding, the differences were significant with the CS (p =
.011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly
increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003),
APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days
of heparin treatment, but there was a considerable overlap with patients without bleeding.
Keywords
Deep venous thrombosis - Heparin treatment - Heparin assays - Bleeding complications
- Retroperitoneal bleeding