The dosage of Anti-Hepa should be guided by blood coagulation studies.Parenteral drug products should be visually inspected for particulate matter and discolouration prior to administration, whenever solution and container permit. Diluted solutions should not be stored since they contain no preservative.Īnti-Hepa should not be mixed with other drugs without knowledge of their compatibility, because Anti-Hepa has been shown to be incompatible with certain antibiotics,including several of the cephalosporins and penicillins.īecause heparin disappears rapidly from the circulation, the dose of Anti-Hepa required also decreases rapidly with the time elapsed following intravenous injection of heparin.For example, if the Anti-Hepa is administered 30 minutes after the heparin, one-half the usual dose may be sufficient. The toxicology of protamine depends on a complex. Įach mg of Anti-Hepa will neutralize approximately 90 units of heparin activity derived from beef lung tissue or about 115 units of heparin activity derived from porcine intestinal mucosa.Īnti-Hepa Injection, should be given by very slow intravenous injection in doses not to exceed 50 mg of Anti-Hepa in any 10 minute period.Īnti-Hepa is intended for injection without further dilution however,if further dilution is desired, 5% Dextrose Injection,or 0.9% Sodium Chloride Injection may be used. Expert opinion: Despite of the low therapeutic index, protamine is the only registered antidote of heparins. In particular, it has been shown that protamine sulfate is capable of transforming and degrading factor Xa to inactive moieties, transforming Xa-AT complexes, promoting the digestive degradation of primary Xa-AT complexes to tertiary complexes, and ultimately promotes a reduction in total complex formulation via the hydrolysis of factor Xa moieties. Īdditionally, studies have also determined that protamine sulfate elicits effects on the clotting factors human factor Xa and human antithrombin (AT). Related studies have also shown that protamine sulfate may be able to decrease intestinal fat absorption and might possess certain antibacterial effects. Furthermore, some animal studies have suggested that the long-term oral administration of protamine sulfate may favourably decrease serum lipid concentrations, presumably by enhancing the actions of the carnitine palmitoyltransferase-2 and acyl-CoA oxidase enzymes. When not complexed with heparin, protamine sulfate by itself demonstrates a weak anticoagulant effect and also evidently prolongs the euglycaemic phase of the human body when used as an excipient in certain injectable insulin formulations. It combines with strongly acidic heparin to form a stable complex, neutralising the anticoagulant activity of both drugs. Although several heparin antidotes have been tested, including small molecules, cationic peptides, and cationic polymers, all have experienced only limited or no clinical success (2629). Despite remaining on a bivalirudin infusion, 3 days from his second PCI, patient developed acute MI and angiography showed 100% thrombosis of his mid-LAD requiring stenting.Protamine sulfate is prepared from the sperm or mature testes of salmon or related species and is composed of arginine, proline, serine and valine. HIT was confirmed with a positive antibody against platelet factor 4. HIT was suspected and the patient was started on a bivalirudin infusion. Labs revealed platelets of 50,000 and troponin-I of 0.270. Angiography showed acute thrombosis at the proximal edge of the mid-LAD stent that was treated with balloon angioplasty. 6 days after his initial PCI, he presented with ST segment elevations in leads V3-V4. All the clotting can lead to large, life-threatening blood clots that block your veins and arteries. Which is used as antidote for heparin Expert opinion: Despite of the low therapeutic index, protamine is the only registered antidote of heparins. Heparin can be neutral- ized by protamine, and warfarin anticoagulation can be reversed by vitamin K injections. All the clotting action uses up your platelets. Traditional anticoagulants have antidotes. He was discharged on aspirin and clopidogrel. Antibodies bind to heparin-PF4, triggering more clotting and so on. Post-PCI intravascular ultrasound (IVUS) images confirmed adequate stent expansion. He underwent an Impella-assisted PCI with three stents from the mid-LM artery to mid-LAD artery. He was given 324 mg aspirin and started on an unfractionated heparin infusion. Heparin Overdose is when a person takes more than the normal or recommended amount of heparin, an anticoagulant that prevents the formation of blood clots. He was hypoxic and hypotensive requiring mechanical ventilation and vasopressors. We present a 57-year-old-male who presented with acute chest pain ECG showed 1-2 mm ST segment elevation in leads I, aVL, V4 and V5.
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