Saved By Leeches

Saved By Leeches

Last Update: 1/03 10:23 am

REPORT: MB #2771

BACKGROUND: Since its discovery in 1916, heparin has been the anticoagulant drug of choice for healthcare professionals. It is used in many transplant surgeries and most cardiac procedures, like treating heart attacks, atrial fibrillation, deep-vein thrombosis and is vital in heart surgery. Some cancer patients and patients on dialysis receive heparin also. About 12 million patients in the United States are given heparin each year. More than one trillion units of heparin are used annually in the United States. About 120,000 patients each year have an allergy to heparin, known as heparin-induced thrombocytopenia, and neither they nor their doctor knows. That lack of awareness could be disastrous.

About 50 percent to 60 percent of all patients who have open-heart surgery develop a heparin antibody. When they return to the emergency room with a blood clot, they are most likely given heparin to unclot it. In a patient who is unknowingly allergic to heparin and given the drug to prevent blood clotting, the very drug supposed to help, in fact, makes it worse. The allergic reaction may cause massive clotting, which can lead to amputation if not treated. Researchers say the blood clots that are "expected" after surgery are actually allergic reactions to the drug, making it difficult for the allergy to be detected right away.

Blood thinners, like heparin, are used in a wide variety of transplant surgeries, but are especially important in open-heart surgeries. Patients must be hooked up to heart lung machines to take over the functions of the heart and lungs during the procedure so doctors can operate on the organs. While on heart lung machines, doctors can perform delicate work without the interference of bleeding or the heart's pumping motion.

BIVALIRUDIN: Bivalirudin (Angiomax) is a synthetic form of a protein found in the saliva of leeches. The drug helps prevent blood clots from forming during and after coronary angioplasty procedures and is usually used along with aspirin. The drug is administered through an IV. Bivalirudin should not be used in patients who have major bleeding as there is a potential for increased bleeding with aspirin and bivalirudin. Some drug interactions can increase the risk of bleeding, so patients currently taking blood thinners, heparin or thrombolytics, such as urokinase, should alert their doctors if undergoing a coronary procedure and may be receiving bivalirudin.

"There is no antidote for bivalirudin," Lawrence Czer, M.D., medical director of Cedar's-Sinai Heart Transplant Program, was quoted as saying. "It has to be administered very carefully, and then you have to filter it out of the system while you are transfusing blood products to reduce the bleeding."

FOR MORE INFORMATION, PLEASE CONTACT:
Cedars-Sinai Medical Center
Patient Information Line
(800) 233-2771

http://www.wptv.com/content/health/mb/story.aspx?content_id=f684dfeb-bf16-46d4-8803-783113a103ca