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Protamine dosing for neutralizing heparin and LMWH

  Heparin in STEMI and PCI – does it help?

The practice of giving STEMI patients anticoagulation has never been based on strong evidence. There are no trials of heparin in STEMI patients undergoing PCI, and the trials of heparin in thrombolysed patients are mixed and have significant flaws. In NSTEMI and unstable angina patients, I think the evidence is clear: anticoagulation is harmful and should not be used. In STEMI, it isn’t clear to me whether anticoagulation results in a net benefit or harm.

 Chemistry professor develops contaminant detection technique for heparin

In 2008, a contaminant eluded the quality safeguards in the pharmaceutical industry and infiltrated a large portion of the supply of the popular blood thinner heparin, sickening hundreds and killing about 100 in the US.

 Is Your Medicine Vegan? Probably Not

When he learned that he would need heparin, an anticoagulant made from the intestinal mucous membranes of pigs, he asked whether he could use fondaparinux, a synthetic substitute, instead. Yes, his doctor told him, the substitution was technically possible — but it would also increase the risk of hemorrhage.

 Moving closer to producing heparin in the lab

Researchers moved one step closer to the ability to make heparin in cultured cells. Heparin is a potent anti-coagulant and the most prescribed drug in hospitals, yet cell-culture-based production of heparin is currently not possible. Heparin is now produced by extracting the drug from pig intestines, which is a concern for safety, sustainability, and security reasons.

 No More Heparin for NSTEMI?

Clinical Take Home Point: Parenteral anticoagulation therapy did not decrease mortality in patients with NSTEMI undergoing PCI but did have more bleeding events compared to non-parenteral anticoagulation therapy. As this is a retrospective review, which has methodological limitations, the findings of this study should be considered hypothesis generating, urging the need for RCTs. At this point in time, with no mortality benefit and increased bleeding risk, I would recommend holding off on parenteral anticoagulation therapy in UA/NSTEMI until I have had a discussion with my consultant about their preference of anticoagulation prior to PCI.

Heparin and low-molecular-weight heparin

Heparin is one of the oldest biological medicines, and has an established place in the prevention and treatment of venous thrombosis. Low-molecular-weight heparins (LMWH) have been developed by several manufacturers and have advantages in terms of pharmacokinetics and convenience of administration. They have been shown to be at least as effective and safe as unfractionated heparin and have replaced the latter in many indications.

Anticoagulant Linked With Lower Risk of Death Following Heart Attack Compared to Heparin

Patients who experienced a certain type of heart attack who received the anticoagulant fondaparinux had a lower risk of major bleeding events and death both in the hospital and after six months compared to patients who received low-molecular-weight heparin (LMWH), although both groups had similar rates of subsequent heart attack or stroke, according to a new study.

Controversial Trial Finds No Benefit For Expensive Medicines Company Drug

The authors conclude that their trial “suggests that the use of heparin, rather than bivalirudin confers significant advantage in the avoidance of major adverse events. This finding might provide an opportunity, rare in modern health care, to provide improved outcomes at much reduced cost.

Dialysis and Heparin: What’s the Evidence?

Many patients suffer bleeding complications while on hemodialysis (HD). Although these events may be as clinically benign as prolonged bleeding after removal of the dialysis needles, they still have a significant impact on a patient who may miss their bus ride home as they sit that extra half hour waiting to clot. On the other hand, the bleeding can be life-threatening such as a cerebral hemorrhage. Heparin is regularly used during dialysis to prevent clotting and allow for efficient dialysis.

Fake Factor V, Heparin, and the Puffy Pregnant Girl

Between bed rest (aka "lazy lump of Kerri), pregnancy (aka "growing awesome baby"), and Factor V (aka "blargh"), I'm at an increased risk of throwing a clot, so precautionary measures are being taken. Namely: compression boots and Heparin shots.

Heparin Does Not Reduce Pregnancy Complications, and May Create Some

A commonly used blood thinner does not appear to lower the risk of blood clots or miscarriage during pregnancy.

Heparin vs. Coumadin

Heparin is an anticoagulant that interferes with the activation of fibrin and keeps it from forming a clot. Coumadin is an anticoagulant that inhibits the action of Vitamin K. Coumadin takes 3-4 days to have the desired effect.

HIT = Heparin-induced Thrombocytopenia

Any patient who receives heparin can develop HIT. HIT occurs in about 2-3% of people who are treated with heparin and in less than 1% of people who are treated with low molecular-weight heparin (LMWH). The LMWH drugs that are available in the United States include dalteparin (Fragmin®), enoxaparin (Lovenox®), and tinzaparin (Innohep®). HIT is more likely to occur with use of higher doses of heparin, but HIT can also be caused by very small heparin doses, including the amount used to flush intravenous catheters.

I’ll take my heparin shots belly up please!

This little syringe of burning love, is what helped women who have had recurrent miscarriages deliver full therm and those who have implantation problems (ME!) finally get a bun in the oven.

Mythbusting: Heparin isn’t beneficial for noninvasive management of NSTEMI

The use of heparin for noninvasive management of non-ST elevation MI (NSTEMI) is one of the most deeply entrenched myths of modern medicine. Although heparin reduces reinfarction, when it is discontinued there is a rebound in infarction rates. Ultimately, short-term treatment with heparin delays reinfarction without having any sustained benefit. Clinical trials which fail to follow patients after discontinuation of anticoagulation incorrectly conclude that heparin is beneficial.

Slimy Pig Intestines Are Not the Best Source of Heparin

The drug is often made from the slimy inner linings of pig intestines, and scientists have found a much safer way to produce it. At the American Chemical Society Meeting, which began in Philadelphia today, Robert Linhardt explained that he can make a dose from one liter of fermented bacteria broth.

The Frightening Heparin Case

The story of a deadly, contaminated blood thinner has laid bare serious deficiencies in the regulatory oversight of drugs imported from China and other developing countries. Congress is rightly determined to plug holes in Food and Drug Administration procedures that leave the American public vulnerable to toxic imports. But that is only half of the problem. It also must ensure that American companies, eager to cut costs by outsourcing, are especially diligent about monitoring their suppliers.

Heparin, grad students, a clinical revolution and giving credit where it's due

The story of a grad student who overcame remarkable odds only to be denied his moment of glory, or a tale of dark deceit and devilish doings? The story of heparin is as complicated as the chemistry itself

Pharm 101: Heparin

Indirect thrombin inhibitor that acts as a co-factor for the antithrombin-protease reaction...

The Heparins

This section compares anticoagulation using unfractionated heparin, low molecular weight heparin and heparinoids.

Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin

in depth review...