Cardiopulmonary bypass in humans: bypassing unfractionated heparin
Review published in The Annals of thoracic surgery (2000)
Abstract
Seven anticoagulants besides unfractionated heparin have been used for human cardiopulmonary bypass (CPB), mainly in patients with heparin-induced thrombocytopenia. The collective experience with these alternative anticoagulants provides a perspective on current efforts aimed at improving CPB anticoagulation. Unfortunately, each alternative currently lacks a standard dosing schedule and a reliable method of monitoring the adequacy of its anticoagulant effect during CPB. Most also lack proven antidotes. Thus, unfractionated heparin remains the anticoagulant of choice for standard CPB.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Review of seven non-heparin anticoagulants used for human cardiopulmonary bypass, mainly in heparin-induced thrombocytopenia; each lacks standard dosing and reliable monitoring, most lack proven antidotes, so unfractionated heparin remains the agent of choice.
Why This Matters for Hirudotherapy
This article examined seven non-heparin anticoagulants used in human cardiopulmonary bypass, primarily in patients with heparin-induced thrombocytopenia, and reported that each lacks a standard dosing schedule, reliable intraoperative monitoring, and for most a proven antidote, so unfractionated heparin remains the anticoagulant of choice. The alternative agents used in this setting include direct thrombin inhibitors such as lepirudin (recombinant hirudin) and bivalirudin (a hirudin analog), both derived from or modeled on the medicinal-leech anticoagulant hirudin, illustrating how leech-secretome compounds have entered clinical practice. An honest caveat is that the abstract does not name the individual seven agents or present new primary trial data, so it provides no direct efficacy or safety evidence for any single hirudin-related drug in CPB.
Citation
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