Heparins cardiac

Full-dose heparin may be used when there are selected indications, such as cardiac sources with a high risk of recurrent embohsm, arterial dissection, or high-grade arterial stenosis prior to surgery (Level of Evidence IV). 

Anticoagulant drugs include heparin and warfarin (Coumadin ) —agents used to prevent deep vein thrombosis. They are also used to prevent formation of emboli due to atrial fibrillation, valvular heart disease, and other cardiac disorders. Heparin, which is not absorbed by the gastrointestinal tract, is available only by injection its effect is immediate. 

This process starts with the synthesis of novel chemical compounds. Substances with complex structures may be obtained from various sources, e.g., plants (cardiac glycosides), animal tissues (heparin), microbial cultures (penicillin G), or human cells (urokinase), or by means of gene technology (human insu-Un). As more insight is gained into structure-activity relationships, the search for new agents becomes more clearly focused. 

Given to patients with a history of typical angina accompanied by either a past medical history of coronary artery disease or ECG/cardiac enzyme changes, low molecular weight heparins (LMWH) were more efficacious in reducing MI and revascularization, but not mortality, with fewer serious side-effects than unfractionated heparin (UFH) (see Magee et al., 2003). 

Type B effects vary depending on the drug used, e.g. heparin and thrombocytopenia, ticlopidine and thrombocytopenia. Clopidrogel shows excellent acceptability. According to the results of phase I and phase II trials, the neurocytoprotectors currently under development have a very variable safety profile. Anti-NMDA agents can induce psychostimulation, psychotomimetic effects and increase blood pressure. For cardiac effects, QTc lengthening is still a problem with eliprodil and lubeluzole. 

Venous stasis resulting from prolonged bed rest, cardiac failure, or pelvic, abdominal, or hip surgery may precipitate thrombus formation in the deep veins of the leg or calf and may lead to fatal pulmonary embolism. Heparin may also be used prophylactically following surgery. 

Apart from its potent antiproliferative activity, tetrasaccharide 15 was effective in blocking human complement in vitro and inhibited the release of heparan sulfate from cardiac microvascular endothelial cells. To overcome hyperacute rejection, the tetrasaccharide has been investigated in a guinea pig to rat cardiac xenotransplantation model and significantly prolonged the survival of heart recipients when compared to control and heparin treated groups [46]. 

Heparin rebound may occur several hours after heparin has been neutralized (usually 8-9 hr after protamine administration). Heparin rebound occurs most often after arterial or cardiac surgery. 

Most major bleeding occurs at arterial access site for cardiac catheterization prior to pulling femoral artery sheath, discontinue heparin for 3-4 hr and document activated clotting time (ACT) <180 sec or aPTT <45 sec achieve sheath hemostasis >4 hr before discharge... 

The agents like protamine sulfate react with the strongly acidic groups of heparin and can abolish its anticoagulant activity. Approximately 1 mg of protamine sulfate neutralizes 80 to 100 units of heparin. It is used only in severe bleeding or when heparin action needs to be terminated rapidly e.g. after cardiac or vascular surgery. 

Amphotericin B is the only polyene antibiotic given parenterally. When the intravenous route is contemplated, amphotericin B is dispersed fresh, as discussed, and infused slowly. Amphotericin B should not be administered rapidly because this causes cardiac toxicity. Heparin (1000 units) is often added to the infusion suspension to avert the risk of thrombophlebitis. Amphotericin B can also precipitate normocytic or normochromic anemia, leukopenia, and thrombocytopenia. 

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