Heparin Substitutes

Heparin is an anticoagulant medication that inhibits the blood's tendency to clot, form new clots, or enlarge an existing clot. Reports in 2007 and 2008 of a large number of adverse reactions to heparin led the primary manufacturer in the United States to stop some of its production of the drug, leading to a shortage. The Food and Drug Administration believes it has traced the problem to the substitution of Chinese-made active ingredients that mimic heparin for the FDA-approved ingredients. Other countries have recalled heparin made from the Chinese active ingredients. Health care professionals are looking for heparin substitutes, as well as "clean" sources of the drug.

Argatroban

• Argatroban is a synthetic direct thrombin inhibitor, a man-made drug that stops, or inhibits, the enzyme thrombin from producing a clot. It is especially useful in treating patients with known heparin-induced thrombocytopenia (low blood platelet count) during cardiopulmonary bypass surgery. Argatroban is not cleared through the liver and works well in patients with renal insufficiency.

Bivalirudin

• Bivalirudin, previously known as hirulog, is a direct thrombin inhibitor. In patients with myocardial infarction -- heart attack caused by the interruption of blood flow to the brain -- bivalirudin reduced the incidence of major hemorrhage, according to a study in the New England Journal of Medicine. When used in patients undergoing fibrinolysis (breaking up a clot), it reduced the incidence of postprocedure myocardial infarction.

Danaparoid Sodium

• Danaparoid is chemically structured like heparin, but requires less patient monitoring than heparin. It has been used during open heart surgeries in patients with heparin-induced thrombocytopenia.

Lepirudin

• Lepirudin is a derivative of hirudin, an anticoagulant found in the saliva of medicinal leeches. It is FDA-approved for treatment of heparin-induced thrombocytopenia. Lepirudin has been used in patients undergoing hemodialysis -- a process of removing waste products from the blood of individuals with kidney disease -- during cardiopulmonary bypass, and also in patients with heparin antibodies.

Warfarin Sodium

• Warfarin sodium is an oral anticoagulant. It is difficult to use because of problems with correct dosing, the need for frequent invasive monitoring, the risk of hemorrhage, and its therapeutic window -- short time interval and concentration at which it is safe.

Warnings

• This information should not be construed as medical advice. Consult your doctor about the need for a heparin substitute.