From the Guidelines
The recommended intraoperative IV dose of heparin for plastic surgery cases is a bolus of 5000 IU or 70-100 IU per kg body weight, followed by continuous infusion with dose adjustment based on patient response, as indicated by the most recent guidelines 1. When considering the administration of heparin in plastic surgery cases, it's crucial to weigh the benefits of preventing thrombosis against the risks of bleeding complications.
- The dose of 5000 IU or 70-100 IU per kg body weight is recommended as a starting point, with adjustments made based on the patient's response, which can be monitored through activated clotting time or activated partial thromboplastin time 1.
- In clinical practice, the timing and dosage may vary depending on the specific procedure, patient risk factors, and surgeon preference.
- For example, in cases of higher risk or more complex procedures, a weight-based dosing approach may be preferred to ensure adequate anticoagulation.
- Monitoring of the patient's coagulation status and being prepared to reverse heparin with protamine sulfate if necessary are also essential components of managing anticoagulation in the intraoperative period.
- The goal is to balance the prevention of thrombotic events with the minimization of bleeding risks, ultimately prioritizing patient safety and outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
2.5 Cardiovascular Surgery Patients undergoing total body perfusion for open-heart surgery should receive an initial dose of not less than 150 units of heparin sodium per kilogram of body weight. Frequently, a dose of 300 units per kilogram is used for procedures estimated to last less than 60 minutes, or 400 units per kilogram for those estimated to last longer than 60 minutes.
The intravenous (IV) dose of heparin for cardiovascular surgery, which is similar to other major surgeries like plastic surgery, is:
- Initial dose: not less than 150 units of heparin sodium per kilogram of body weight
- Procedure < 60 minutes: 300 units per kilogram
- Procedure > 60 minutes: 400 units per kilogram 2
From the Research
Intravenous Dose of Heparin for Plastic Surgery Cases
- The intravenous dose of heparin (unfractionated heparin) for plastic surgery cases intraoperatively is not explicitly stated in most of the provided studies 3, 4, 5.
- However, one study suggests that a single dose of 5000 units of sodium heparin given intravenously during operation may be a safe and effective means of prophylaxis against deep-vein thrombosis in patients who undergo general surgical procedures 6.
- Another study evaluated the pharmacodynamics of weight-based dose heparin infusions and found that a dose of 10 units/kg/hour may provide adequate prophylaxis for some patients, but most patients require dose adjustments to ensure adequate VTE prophylaxis 7.
- The optimal dose of heparin, time of administration, and duration of anticoagulation are still being studied and have not been definitively established for plastic surgery cases intraoperatively 6.
Key Findings
- A study on abdominoplasty patients found that preoperative chemoprophylaxis with heparin (unfractionated) 5000 units s.q. on call to the OR did not increase bleeding complications or overall complication rate 4.
- Another study found that weight-based heparin infusions at a rate of 10 units/kg/hour provide a detectable level of anticoagulation for some patients following microsurgical procedures, but most patients require dose adjustment to ensure adequate VTE prophylaxis 7.