End of the road for heparin thromboprophylaxis

Abstract

In this issue of Blood, McGowan et al show that institution-wide replacement of unfractionated heparin (UFH) with low-molecular-weight heparin (LMWH) substantially reduces the burden of heparin-induced thrombocytopenia (HIT).1 Because it is well-established that LMWH is less likely to cause this highly prothrombotic adverse drug reaction than UFH,2 it seems intuitive, at first, that using less UFH would reduce the incidence of HIT. However, implementing this policy at a system-wide level is far from simple. The in-hospital unit cost of LMWH is 6- to 8-fold higher than that of UFH (average, $3 vs $24 per day in 2013 US dollars)3 and, in an age where providing venous thromboprophylaxis is mandatory for hospitalized patients, choosing UFH is like picking low-hanging fruit for cost-conscious institutions. The absence of compelling data showing that LMWH is more effective than UFH for thromboprophylaxis or treatment does nothing to discourage this practice.4,5