From the Research
Heparin therapy after acute limb ischemia should be continued for 24-72 hours following successful revascularization, as recommended by the most recent and highest quality study 1. The duration of heparin therapy depends on the patient's clinical status and underlying cause, with the goal of preventing immediate rethrombosis and promoting limb salvage.
- For patients who have undergone surgical embolectomy or thrombectomy, heparin is usually administered for 24-48 hours post-procedure.
- In cases where endovascular interventions were performed or when there's a high risk of recurrent thrombosis, heparin may be continued for up to 72 hours. The initial treatment involves unfractionated heparin with an IV bolus of 80-100 units/kg followed by continuous infusion at 18 units/kg/hour, adjusted to maintain aPTT at 1.5-2.5 times normal, as supported by previous studies 2, 3. Low molecular weight heparin (such as enoxaparin 1mg/kg twice daily) may be used as an alternative, particularly when transitioning to outpatient care. Following the initial heparin therapy, patients should transition to oral anticoagulation with warfarin (target INR 2-3) or direct oral anticoagulants if the ischemia was caused by an embolic or thrombotic event, as recommended by recent literature 1, 4. This transition should begin while the patient is still on heparin, with the heparin discontinued once therapeutic oral anticoagulation is achieved. Heparin works by enhancing antithrombin activity, preventing further clot formation while the body's natural fibrinolytic system works to dissolve existing clots, making it essential in the immediate post-revascularization period, as highlighted in a recent review 2.