What should be done when resuming heparin after it was previously stopped?

When resuming heparin therapy after it has been stopped, the recommended practice is to return to the last effective dose, which was based on achieving target therapeutic levels as indicated by anti-Xa monitoring. This approach ensures that the patient receives an appropriate dose that was previously shown to be effective in preventing thromboembolic events without unnecessarily increasing the risk of complications associated with either overanticoagulation or underanticoagulation.

Using the last dose where anti-Xa was in goal allows for a more personalized and evidence-based approach to anticoagulation therapy. It takes into account the patient's unique response to heparin, previous monitoring results, and clinical condition, ensuring that the resumption of therapy aligns with established therapeutic targets.

Starting at a lower dose than before might not adequately prevent thrombotic complications, especially if the patient requires the same anticoagulation level as prior to discontinuation. Increasing the dose significantly to "catch up" could place the patient at undue risk for bleeding complications, as it may lead to overanticoagulation. Consulting with the pharmacy for a new dose may be necessary in some clinical scenarios, but this should not override the established practice of reverting to the previously successful dose unless there are specific clinical reasons to adjust