Consensus Guidelines for Australian Clinicians for the usage of anti-coagulants during heparin-based product shortages

Clinical categories and priorities for heparin based product usage

Guidelines to assist with contingency planning to manage the clinical implications of a shortage of heparin based products.

Page last updated: 16 July 2008

PDF printable version of Consensus Guidelines for Australian Clinicians for the use of anti-coagulants during heparin-based product shortages (PDF 135 KB)

The AHPC Group considers that there are three groups of patients in prioritising usage of heparin based products in the event of a shortage. These groups are:

Group 1 - Patients requiring active treatment for acute thromboembolic disorders

For example:
  • Treatment of venous thrombosis and pulmonary embolism
  • Patients on anticoagulant therapy for thrombosis with a current history of cancer
  • Management of acute coronary syndrome
  • Embolic stroke patients

Group 2 - Patients requiring anticoagulant support for investigative and therapeutic procedures

For example:

  • Conditions in which there is no alternative to heparin with risk of significant patient morbidity and mortality if heparin is not available. For example:
    • Haemodialysis patients. Haemodialysis cannot be performed without anticoagulation and patients will survive 4-5 days only without a haemodialysis session.
    • Support for cardiopulmonary bypass procedures
  • Conditions resulting in significant patient morbidity that may be relieved by endovasculartechniques which require heparin cover to minimise risk of arterial or venous thrombosis For example:
    • limb ischaemia with rest pain,
    • elective abdominal aortic aneurysm
  • Elective or semi elective procedures for non-life threatening but life limiting conditions requiring intra-arterial or intra-venous bolus heparin use such as performed for lower limb claudication (pain with walking or exercise). This group at lower priority in the event of a shortage is also likely to be the largest.

Within Group 2, some procedures may be performed acutely, semi-electively and electively, and their prioritisation in the event of a heparin based products shortage should be determined by the relevant craft group according to clinical urgency and other relevant factors. For example: coronary angiography.

Group 3 - High risk patients receiving thromboprophylaxis

For example:
  • Patients undergoing major surgery particularly of the abdomen,
  • Patients with congestive cardiac failure
  • Patients with fractures of the lower limb
  • Prophylaxis for pregnant women at risk of thromboembolism
  • Patients having total hip or total knee arthroplasty (in the absence of sufficient supplies of fondaparinux as a substitute).

The AHPC group agrees that in the event of a shortage of heparin based products, usage across these three groups of patients should be prioritised according to clinical need as follows on the next page.