Porcine Mucosal Heparin Shortage Crisis! What Are the Options?

Current dramatic developments concerning heparins and related drugs have been the focus of important discussions at several regulatory, clinical, and scientific levels. Unfractionated heparin is the most important of all the glycosaminoglycan drugs, without which, surgical and interventional procedures, hemodialysis, and surface coating of devices would not be possible. A better understanding of glycosaminoglycans has helped further their subsequent development. Heparin is the only anticoagulant with an effective antidote, protamine sulfate. Beyond heparin, related glycosaminoglycans such as sulodexide, hemoclar, and danaparoid are used for a variety of clinical indications. Sulodexide is a blended preparation containing low-molecular-weight heparin (LMWH) and dermatan sulfate as their main active components. Parenteral antithrombin agents such as argatroban and bivalrudin are used for anticoagulation but do not have a reliable antidote. Fondaparinux can be used parenterally but is devoid of any measurable anticoagulant effects in human blood.