Intraoperative low molecular weight heparin and postoperative bleeding

A case of postoperative bleeding associated with low molecular weight heparin (LMWH) administration is reported. A literature search suggests that perioperative bleeding can be as high as 11% when LMWH is administered intraoperatively. When administered 6 h postoperatively, LMWH does not signi-ficantly increase the risk of bleeding whilst retaining efficacy for venous thromboembolism prop-hylaxis. Although LMWH has not been shown to be superior when compared to unfractionated heparin for general surgery, advantages include no need for monitoring and once daily dosage. During an acute bleeding episode, bedside functional monitoring (e.g. thromboelastography) is appropriate rather than anti-Xa levels. To reverse LMWH, use protamine first to reverse its effects partially, followed by replenishing factor X and II with FFP/Prothrombinex. If bleeding continues, consider using activated factor VIIa.