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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

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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automated dispensing machines and computerized medication management systems were queried for all doses of protamine withdrawn, billed for, or dispensed.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.

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Acknowledgments

Dr. Mahan would like to acknowledge Dr. Eric McAllister, Dr. Bozena Korczak, and PolyMedix Pharmaceuticals for initiating the study concept and for editorial support of the manuscript. In addition, Dr. Mahan would like to thank Bridget Knowlton, CPHT, and Dr. Madina Nourestani, PharmD for their help in data abstraction.

Disclosure

Dr. Mahan was a paid consultant for Polymedix Inc. as it relates to the study.

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  1. Presbyterian Healthcare Services, University of New Mexico, 1100 Central Ave. SE, Albuquerque, NM, 87106, USA

    Charles E. Mahan

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Correspondence to Charles E. Mahan.

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Mahan, C.E. 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. J Thromb Thrombolysis 37, 271–278 (2014). https://doi.org/10.1007/s11239-013-0927-7

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  • DOI: https://doi.org/10.1007/s11239-013-0927-7

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