From the FDA Drug Label
HEPARIN SODIUM INJECTION is an anticoagulant indicated for • Prevention of clotting in arterial and cardiac surgery • Prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease
The recommended anticoagulation therapy after Cardiothoracic Surgery (CTS) is heparin.
- The dosage is not specified in the context of CTS, but the general dosage recommendations for heparin are provided in the label.
- It is essential to follow the recommended adult dosages and adjust the dose based on laboratory monitoring to ensure safe and effective use of heparin 1.
From the Research
Anticoagulation after cardiothoracic surgery (CTS) should be individualized based on patient-specific risk factors, with a focus on balancing the prevention of thrombotic complications against the risk of bleeding. For most patients, low-dose aspirin (81-325 mg daily) should be started within 6-24 hours after surgery if there is no excessive bleeding 2. The choice of anticoagulant and duration of therapy should be guided by the patient's underlying condition, such as mechanical heart valves, atrial fibrillation, or coronary artery bypass graft (CABG) 3, 4. In general, patients with mechanical heart valves should receive warfarin with a target INR of 2.0-3.0 for aortic valves and 2.5-3.5 for mitral valves, while those with CABG and recent acute coronary syndrome or stent placement should receive dual antiplatelet therapy with aspirin and clopidogrel (75 mg daily) 5. Direct oral anticoagulants (DOACs) may be considered as an alternative to warfarin in certain patients, particularly those with atrial fibrillation and a CHA₂DS₂-VASc score ≥2 4. Prophylactic anticoagulation with subcutaneous heparin or enoxaparin should be used for all immobilized patients to prevent venous thromboembolism 6. Key considerations in selecting an anticoagulant regimen include the patient's risk of thromboembolism, bleeding risk, and renal function, as well as the potential for drug interactions and the need for monitoring 2, 4. Ultimately, the goal of anticoagulation therapy after CTS is to minimize the risk of thrombotic complications while avoiding excessive bleeding, and individualized treatment plans should be developed based on a thorough assessment of each patient's unique needs and risk factors.