Bleeding complications of unfractionated heparin

INTRODUCTION: Unfractionated heparin is an anticoagulant used in the treatment of myocardial infarction, pulmonary embolism and other thrombotic disorders. However, with anticoagulation comes the risk of bleeding and adverse events. These risks increase with supratherapeutic dosing. AREAS COVERED: In this review, we discuss the reasons for supratherapeutic dosing, and the incidence of adverse events and clinical consequences of the same, with a focus on heparin use in acute coronary syndromes. We also provide some opportunities for safer use of intravenous heparin. At the end of this article, the reader should have a better understanding of the proper use of heparin as well as the magnitude of bleeding and a respect for its consequences. EXPERT OPINION: Heparin is an indispensable anticoagulant used in a number of clinical scenarios. Careful attention must be paid to dosing in order to minimize the risk of bleeding and related adverse events including death. The use of weight-based nomograms is paramount. Devices to automate testing and titration are currently under development.