We are currently experiencing a critical shortage of manufactured unfractionated heparin IV bags (UFH).  

Our Tier 1: Guidelines for Initial Anticoagulation in Venous Thromboembolism and Atrial Fibrillation should be used as the go-to tool to guide anticoagulation management; however, to conserve heparin supply, please see the following recommendations for alternatives: 

• Atrial fibrillation, Arterial/Venous thrombosis (DVT/PE, intra-cardiac thrombus), Direct Current Cardioversion (DCCV)
  • DOAC (apixaban, rivaroxaban)
    • First-line unless contraindicated
    • In renal failure, apixaban is still a viable option
  • Enoxaparin
    • For patients unable to tolerate oral therapy and/or parenteral anticoagulation is needed

• Mechanical heart valves
  • Enoxaparin first-line unless contraindicated

• ACS (UA/NSTEMI/STEMI)
  • Enoxaparin first-line unless contraindicated

• IV UFH may be used in the following areas/indications:
  • Periprocedural/OR
  • EKOS procedure for DVT and/or PE
  • Mechanical circulatory support devices
  • ESRD requiring anticoagulation
  • Critically ill patients in shock

• VTE prophylaxis
  • At this time, adequate supply of heparin sub Q is available for prophylaxis, however, enoxaparin and rivaroxaban 2.5 mg PO BID should be considered where applicable

If we run out of heparin, more details will be provided regarding recommendations for direct thrombin inhibitors (bivalirudin, argatroban). 

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