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 disordersFor 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 proceduresFor example:
- Conditions in which there is no alternative to heparin with risk of significant patient morbidity and mortality if heparin is not available.
- 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
- 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 thromboprophylaxisFor 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.
This publication is available as a downloadable document.