Key result
Hexadimethrine reversed heparin-induced anticoagulation as effectively as protamine, whereas methylene blue and vancomycin did not neutralize heparin in vitro.
Why the study?
Does methylene blue, hexadimethrine, or vancomycin reverse heparin-induced anticoagulation in blood from cardiopulmonary bypass circuits compared to protamine?
Does methylene blue, hexadimethrine, or vancomycin reverse heparin-induced anticoagulation in blood from cardiopulmonary bypass circuits compared to protamine?
Hexadimethrine effectively reverses heparin-induced anticoagulation in vitro, suggesting it may serve as a viable alternative to protamine for patients with protamine allergy.
Answers are grounded in this paper and cite their sources.
Hexadimethrine merits further evaluation as protamine alternative; leaves open prospective animal and clinical validation before any practice consideration.
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 micrograms/mL), methylene blue (13.5, 27.0, 135.1, 202.7, 270.3, 337.8, 405.4, 473.0, 540.5, and 810.8 micrograms/mL), hexadimethrine (6.8, 13.5, 20.3, 27.0, 81.1, and 135.1 micrograms/mL), or vancomycin (13.5, 27.0, 135.1, 270.3, 540.5, and 810.8 micrograms/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 micrograms/mL and at hexadimethrine concentrations of 81.1 and 135.1 micrograms/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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Kikura et al. (1996) studied Heparin reversal after cardiopulmonary bypass (n=18). Methylene blue, hexadimethrine, or vancomycin vs. Protamine and heparinase-ACT was evaluated on Activated clotting time (ACT) complete reversal compared to heparinase-ACT. Hexadimethrine reversed heparin-induced anticoagulation as effectively as protamine, whereas methylene blue and vancomycin did not neutralize heparin in vitro.
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