Assembly of the Heparin Removal Device for patients with suspected adverse reaction to protamine sulphate

Abstract

Protamine sulphate is routinely used after cardiopulmonary bypass (CPB) to restore the patient's baseline coagulatory state. However, adverse reactions are encountered, and alternative means to neutralize heparin are, therefore, necessary. The Heparin Removal Device (HRD) constitutes an extracorporeal circuit that allows ex vivo deheparinization by mean of a polycationic ligand that binds heparin molecules. This paper presents the setup of the HRD circuit. It is illustrated by the report of a 68-year-old man with a known severe crustacean allergy. The patient (78 kg, 170 cm) was admitted for elective coronary artery bypass graft surgery. It was decided that the HRD would be used as a precaution in order to avoid the risks of using protamine sulphate. The CPB time and aortic crossclamp time were 70 and 40 min, respectively. At the end of CPB, the device was inserted and processing started. Activated coagulation time values were monitored over a 130 min period and diminished from 480 to 300 s after 45 min, 220 s after 90 min, and settled at 150 s. Haemostasis was acceptable and processing stopped. The operation was terminated and the patient transferred to the intensive care unit. Clinical evolution was excellent, with minimal postoperative bleeding. The HRD presents an alternative to protamine sulphate when this drug is contraindicated for a certain patient population who might have a suspected, known or emergency adverse reaction.

pH-Sensitive Genipin-Cross-Linked Chitosan Microspheres For Heparin Removal

“…Many attempts to construct a heparin removal device, mostly containing immobilized poly- l -lysine, have been undertaken. ,− Despite the promising experimental data, there has been only limited experience with such heparin removal devices, and none of them have been clinically implemented until now. A method frequently used to avoid complications brought about by free heparin antagonists is their immobilization on polymeric supports.…”

Alternatives to heparin anticoagulation for cardiopulmonary bypass and extracorporeal membrane oxygenation

“…Thirdly, heparin may be neutralized either by a heparin removal device or novel drugs such as heparinase and hexadimethrine, although these have not yet been widely adopted. [50][51][52][53][54][55] Finally, anticoagulation can be achieved using another drug in lieu of heparin, thus forgoing the need for reversal with protamine.…”