Fatal Hematoma during Treatment with Adjusted-Dose Subcutaneous Heparin Therapy

To the Editor: Subcutaneous heparin therapy for atrial fibrillation, deep-vein thrombosis, unstable coronary syndromes, or ischemic cerebral attacks may be an alternative to intravenous treatment, if there are contraindications to oral anticoagulants and mobilization of the patient or discharge from the hospital is desired. Unfortunately, few studies support this practice. With the method of adjusted-dose treatment with heparin, the drug is given subcutaneously, and the partial-thromboplastin time is monitored. Daily adjustment of the dose can result in effective prolongation of the partial-thromboplastin time. The same prophylactic effect is expected with the adjusted-dose method as with the well-studied intravenous use of . . .