![]() Bivalirudin is currently available as an anticoagulant and eliminates the need for an antidote, due to its short half-life of 25 minutes. With no promising leads, alternatives to the heparin and protamine combination were also considered. Of the agents listed, the following are currently under investigation in pre-clinical studies: heparinase, UHRA, riAT, Dex40-GTMAC3, HRG plus zinc, quaternized chitosan derivative, and LMWP. Based on the available literature, the following compounds have been investigated as alternatives: hexadimethrine bromide, heparinase, platelet factor 4 (PF4), heparin removal devices, synthetic protamine variants, methylene blue, vancomycin, tolonium chloride, ciraparantag, universal heparin reversal agent (UHRA), Dex40-GTMAC3, histidine-rich glycoprotein (HRG) plus zinc, and recombinant inactive antithrombin (riAT), low molecular weight protamine (LMWP), quaternized chitosan derivative. Results:Ĭurrently, there is no FDA approved alternative to protamine however, multiple products have been considered for potential use. A literature search was conducted during the month of July 2019 in Medline, Embase, and International Pharmaceutical Abstracts using the following search terms: “heparin,” “antidote,” “protamine,” "cardiopulmonary bypass,” “reversal,” “unfractionated heparin,” and ''alternative.” Studies evaluating possible alternatives for the reversal of protamine were included in this review. Methods: An inquiry was submitted to the Christy Houston Drug Information Center (DIC) at the Belmont University College of Pharmacy in July 2019 regarding alternatives to protamine for unfractionated heparin reversal during a protamine shortage. This literature review provides currently available alternatives for protamine when the use of unfractionated heparin is unavoidable. Use of protamine alone produces a weak anticoagulation effect but when used in combination with heparin, a strong acid, a salt is formed which neutralizes the compound’s activity. Protamine is the only FDA approved reversal agent for heparin. ![]() An evidence based approach for managing drug shortages allows clinicians to provide safe and effective patient care. Purpose: A recent possibility of protamine shortage prompted an inquiry for available alternatives for unfractionated heparin reversal. ![]() 2019 Midyear Clinical Meeting Skip to main content ![]()
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