title: A 1-year drug utilization evaluation of protamine in hospitalized patients to identify possible future roles of heparin and low molecular weight heparin reversal agents.
abstract: Despite widespread use of unfractionated heparin (UFH) and low molecular weight heparin (LMWH), protamine sulfate remains the only reversal agent for UFH that is approved by the Food and Drug Administration within the US. Availability of new reversal agents for approved anticoagulants and those in development may improve patient safety and care. Delparantag (PMX-60056) is a novel small molecule that shows ability to neutralize the anticoagulation effects of UFH and LMWH in animals and humans. This study examined the 1-year utilization of protamine within an acute care hospital in order to determine the need for a novel reversing agent like delparantag. All patients having documented protamine administration within a 1-year period were included. Pharmacy automated dispensing machines and computerized medication management systems were queried for all doses of protamine withdrawn, billed for, or dispensed. Scanned medical records were reviewed and protamine and anticoagulant information was abstracted. Primary procedural group categorizations for protamine patients were coronary artery bypass graft, cardiac valve surgeries, abdominal aortic aneurysm and other open abdominal surgeries, fistula placement, non-cardiac vascular, cardiac catheter and electrophysiology lab, and "other." Average doses of protamine administered were 439, 423, 126, 26, 46, 36, and 35 mg in these groups, respectively. Four major bleeds and one serious adverse event occurred over the year period. Protamine is used in a wide array of procedures. Evaluating protamine's current use may be beneficial in identifying roles for future UFH and LMWH reversal agent use.
authors: Presbyterian Healthcare Services, University of New Mexico, 1100 Central Ave. SE, Albuquerque, NM, 87106, USA, chmahan@yahoo.com.
authors: Charles E
authors: CE
authors: Mahan
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000628:therapy*; D006494:Heparin Antagonists / Q000008:administration & dosage*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008510:Medication Systems, Hospital; D011479:Protamines / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D006494:Heparin Antagonists; D006495:Heparin, Low-Molecular-Weight; D011479:Protamines
references: Eur J Pharmacol. 2010 Jun 10;635(1-3):165-70
references: 20307530
references: N Engl J Med. 2010 Oct 21;363(17):1597-607
references: 20961243
references: Circulation. 1996 Jun 15;93(12):2212-45
references: 8925592
references: Chest. 2012 Feb;141(2 Suppl):e326S-e350S
references: 22315266
references: Org Biomol Chem. 2006 Oct 21;4(20):3763-8
references: 17024282
references: Clin Appl Thromb Hemost. 2010 Aug;16(4):377-86
references: 20460347
references: Glycobiology. 2012 Sep;22(9):1183-92
references: 22641771
references: Pharmacotherapy. 2006 Oct;26(10):1438-45
references: 16999654
references: J Thromb Haemost. 2005 Apr;3(4):692-4
references: 15842354
references: Chest. 2008 Jun;133(6 Suppl):299S-339S
references: 18574269
references: Chest. 2002 Jul;122(1):108-14
references: 12114345
references: Chest. 2012 Feb;141(2 Suppl):e120S-e151S
references: 22315258
references: Chest. 2008 Jun;133(6 Suppl):141S-159S
references: 18574264
references: Thromb Haemost. 2012 Aug;108(2):291-302
references: 22739656
references: Chest. 2008 Jun;133(6 Suppl):340S-380S
references: 18574270
references: Chest. 2008 Jun;133(6 Suppl):234S-256S
references: 18574267
references: Blood. 2011 Feb 10;117(6):2054-60
references: 21048158
references: Thromb Res. 2011 Oct;128(4):e9-13
references: 21496885
references: FEBS J. 2013 May;280(10):2523-32
references: 23374371
references: Curr Pharm Des. 1999 Dec;5(12):965-86
references: 10607857
references: Chest. 2012 Feb;141(2 Suppl):e24S-e43S
references: 22315264
references: Am J Hematol. 2007 Sep;82(9):777-82
references: 17626254
references: J Thromb Haemost. 2010 Jan;8(1):202-4
references: 19878532
references: J Thromb Haemost. 2003 Apr;1(4):760-5
references: 12871413
references: Circulation. 2010 Aug 10;122(6):614-22
references: 20660806
references: Chest. 2008 Jun;133(6 Suppl):454S-545S
references: 18574272
references: Thromb Haemost. 2008 Dec;100(6):1130-5
references: 19132240
references: Eur Heart J. 2013 Aug;34(31):2481-9
references: 22859796
references: Eur Heart J. 2011 Oct;32(19):2412-9
references: 21724623
references: JAMA. 2001 May 9;285(18):2370-5
references: 11343485
references: Braz J Med Biol Res. 2012 Oct;45(10):929-34
references: 22735179
references: Br J Haematol. 2000 Mar;108(4):884-5
references: 10858037
references: Am J Kidney Dis. 2004 Mar;43(3):531-7
references: 14981611
references: Obes Surg. 2004 May;14(5):695-8
references: 15186641
references: Thromb Res. 2010 Nov;126(5):e403-5
references: 20870279
references: Am Heart J. 2011 Feb;161(2):261-268.e1-2
references: 21315207