Subcutaneous heparin treatment.

The effect of low‐dose heparin on blood loss at abdominal hysterectomy

“…While most trials have failed to show any major difference in bleeding at the time of operation (Kakkar 1978), there are many reports of increased postoperative bleeding and haematornas (International Multicentre Trial 1975;Allen et al 1978;Gallus et al 1976). On the other hand, some reports have made much of the occasional patient in whom serious bleeding seemed to be related to heparin usage (Arden et al 1972;McWilliam et al 1974). These factors have been enough to deter surgeons from wholeheartedly adopting this method of prophylaxis.…”

Trial of a single low dose of heparin in the prevention of post-operative deep-vein thrombosis monitored by doppler ultrasound

“…Excessive bleeding has not been a major problem in most published series (Sharnoff et al, 1962;Kakkar et al, 1972;Williams, 1971;Gordon-Smith et al, 1972;Nicolaides et al, 1972) although there have been reports of massive wound haematomas after hip surgery (Charnley, 1972;Arden, Powell and Fell, 1972). Although it is not possible to say whether or not the post-operative bleeding in two patients in the present series was due to heparin, it seems possible that there is a small risk which should be considered when low-dose heparin is given.…”

Invited commentary

“…This observation combined with several anecdotal reports of wound hematomas [4,5,6,[8][9][10] or fatal hemorrhages in patients receiving low-dose subcutaneous heparin has been enough to make many surgeons cautious. In one hospital the routine use of this method of prophylaxis has been discontinued because of postoperative bleeding in 6 patients (lifethreatening in 3), and the frequent finding of prolonged thrombin clotting times [ 11]. Direct evidence for an increased incidence of wound hematomas has *Group A compared with controls X 2 = 4.5 (p < 0.05).…”