Adverse Effects

The major adverse reaction resulting from heparin therapy is hemorrhage. Bleeding can occur in the urinary or gastrointestinal tract and in the adrenal gland. Subdural hematoma, acute hemorrhagic pancreatitis, hemarthrosis, and wound ecchymosis also occur. The incidence of life-threatening hemorrhage is low but variable. Heparin-induced thrombocytopenia of immediate and delayed onset may occur in 3 to 30% of patients. The immediate type is transient and may not involve platelet destruction, while the delayed reaction involves the production of heparin-dependent an-tiplatelet antibodies and the clearance of platelets from the blood. Heparin-associated thrombocytopenia may be associated with irreversible aggregation of platelets (white clot syndrome). Additional untoward effects of heparin treatment include hypersensitivity reactions (e.g., rash, urticaria, pruritus), fever, alopecia, hypoal-dosteronism, osteoporosis, and osteoalgia.

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