Abstract
There are no clinically available alternatives for reversing heparin in protamine-allergic patients. This study examined the ability of methylene blue, hexadimethrine, and vancomycin to reverse circulating heparin so that these compounds can be carefully examined in future placebo-controlled studies in humans. Heparin activity in blood obtained from extracorporeal circuits was reversed by adding protamine (13.5, 27.0, 81.1, 135.1, and 270.3 μg/mL), methylene blue (13.5, 27.0, 135.1, 202.7, 270.3, 337.8, 405.4, 473.0, 540.5, and 810.8 μg/mL), hexadimethrine (6.8, 13.5, 20.3, 27.0, 81.1, and 135.1 μg/mL), or vancomycin (13.5, 27.0, 135.1, 270.3, 540.5, and 810.8 μg/mL), and activated clotting times (ACTs) were measured with kaolin (n = 18). Heparinase-ACT was obtained to determine complete reversal. Heparin concentrations were 3.3 ± 0.3 U/mL with ACT values of 485 ± 97 s. The ACT at a protamine concentration of 81.1 μg/mL and at hexadimethrine concentrations of 81.1 and 135.1 μg/mL was not statistically different from heparinase-ACT; however, methylene blue or vancomycin did not reverse the anticoagulation at any concentrations. Hexadimethrine can reverse heparin- induced anticoagulation after cardiopulmonary bypass as well as protamine, although methylene blue or vancomycin did not neutralize heparin in vitro.
| Original language | English |
|---|---|
| Pages (from-to) | 223-227 |
| Number of pages | 5 |
| Journal | Anesthesia and Analgesia |
| Volume | 83 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 1996 Aug 16 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
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Heparin neutralization with methylene blue, hexadimethrine, or vancomycin after cardiopulmonary bypass. / Kikura, Mutsuhito; Lee, Mi Kyoung; Levy, Jerrold H.
In: Anesthesia and Analgesia, Vol. 83, No. 2, 16.08.1996, p. 223-227.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Heparin neutralization with methylene blue, hexadimethrine, or vancomycin after cardiopulmonary bypass
AU - Kikura, Mutsuhito
AU - Lee, Mi Kyoung
AU - Levy, Jerrold H.
PY - 1996/8/16
Y1 - 1996/8/16
N2 - There are no clinically available alternatives for reversing heparin in protamine-allergic patients. This study examined the ability of methylene blue, hexadimethrine, and vancomycin to reverse circulating heparin so that these compounds can be carefully examined in future placebo-controlled studies in humans. Heparin activity in blood obtained from extracorporeal circuits was reversed by adding protamine (13.5, 27.0, 81.1, 135.1, and 270.3 μg/mL), methylene blue (13.5, 27.0, 135.1, 202.7, 270.3, 337.8, 405.4, 473.0, 540.5, and 810.8 μg/mL), hexadimethrine (6.8, 13.5, 20.3, 27.0, 81.1, and 135.1 μg/mL), or vancomycin (13.5, 27.0, 135.1, 270.3, 540.5, and 810.8 μg/mL), and activated clotting times (ACTs) were measured with kaolin (n = 18). Heparinase-ACT was obtained to determine complete reversal. Heparin concentrations were 3.3 ± 0.3 U/mL with ACT values of 485 ± 97 s. The ACT at a protamine concentration of 81.1 μg/mL and at hexadimethrine concentrations of 81.1 and 135.1 μg/mL was not statistically different from heparinase-ACT; however, methylene blue or vancomycin did not reverse the anticoagulation at any concentrations. Hexadimethrine can reverse heparin- induced anticoagulation after cardiopulmonary bypass as well as protamine, although methylene blue or vancomycin did not neutralize heparin in vitro.
AB - There are no clinically available alternatives for reversing heparin in protamine-allergic patients. This study examined the ability of methylene blue, hexadimethrine, and vancomycin to reverse circulating heparin so that these compounds can be carefully examined in future placebo-controlled studies in humans. Heparin activity in blood obtained from extracorporeal circuits was reversed by adding protamine (13.5, 27.0, 81.1, 135.1, and 270.3 μg/mL), methylene blue (13.5, 27.0, 135.1, 202.7, 270.3, 337.8, 405.4, 473.0, 540.5, and 810.8 μg/mL), hexadimethrine (6.8, 13.5, 20.3, 27.0, 81.1, and 135.1 μg/mL), or vancomycin (13.5, 27.0, 135.1, 270.3, 540.5, and 810.8 μg/mL), and activated clotting times (ACTs) were measured with kaolin (n = 18). Heparinase-ACT was obtained to determine complete reversal. Heparin concentrations were 3.3 ± 0.3 U/mL with ACT values of 485 ± 97 s. The ACT at a protamine concentration of 81.1 μg/mL and at hexadimethrine concentrations of 81.1 and 135.1 μg/mL was not statistically different from heparinase-ACT; however, methylene blue or vancomycin did not reverse the anticoagulation at any concentrations. Hexadimethrine can reverse heparin- induced anticoagulation after cardiopulmonary bypass as well as protamine, although methylene blue or vancomycin did not neutralize heparin in vitro.
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UR - http://www.scopus.com/inward/citedby.url?scp=0030017370&partnerID=8YFLogxK
U2 - 10.1097/00000539-199608000-00004
DO - 10.1097/00000539-199608000-00004
M3 - Article
VL - 83
SP - 223
EP - 227
JO - Current researches in anesthesia & analgesia
JF - Current researches in anesthesia & analgesia
SN - 0003-2999
IS - 2
ER -