From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Heparin prophylaxis can be started immediately after a gastrointestinal bleed in patients undergoing hemodialysis, as evidenced by a study where 86% of patients received heparin at a median dose of 4,000 units with their first outpatient HD session after discharge from GI bleeding, without an increased risk of death or recurrent GI bleeding 1. When considering the resumption of heparin prophylaxis after a gastrointestinal bleed, it's crucial to weigh the risks of thrombosis against the risks of recurrent bleeding. The decision should be individualized based on the patient's specific risk factors for both conditions.
- Key factors to consider before restarting heparin include:
- Hemodynamic stability
- No evidence of ongoing bleeding
- Stable hemoglobin levels for at least 24-48 hours without transfusion requirements
- Normalization of vital signs
- Standard prophylactic dosing of unfractionated heparin is typically 5,000 units subcutaneously every 8-12 hours.
- For patients at high risk of thrombosis, earlier resumption of heparin may be considered with close monitoring, as suggested by studies on venous thromboprophylaxis in gastrointestinal bleeding 2.
- Conversely, for patients with a high risk of rebleeding, prophylaxis might be delayed further, or mechanical methods like sequential compression devices could be used initially. The most recent and highest quality study on this topic is from 2014, which found that heparin use in hemodialysis patients following gastrointestinal bleeding did not increase the risk of recurrent bleeding or death 1. This study provides the strongest evidence for guiding clinical practice in this area.