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Annotations Adverse Effects

Adverse effects

  • Bleeding:
    • Most common adverse effect.
    • Discontinue heparin.
    • Refer to Heparin antidote section for management.
  • Osteoporosis:
    • Uncommon.
    • Occurs with prolonged heparin therapy.
    • Monitor bone density if heparin therapy exceeds 3 months.
  • Thrombocytopenia due to heparin-induced thrombocytopenia (HIT):
    • Risk in children < 2%.
    • May be asymptomatic.
    • May be associated with life threatening or fatal arterial or venous thrombosis.
    • So    Suspect HIT if platelet count decreases by 50% or decreases below 150,000/microL between day 5 and 10 of heparin exposure (may occur sooner if patient has previously been exposed to heparin).
    • Consult Hematology if HIT is suspected.


These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.

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