Ancrod: A practical alternative to heparin

Abstract

To rapidly start systemic anticoagulation there are few alternatives to heparin; those that may be used are often less effective and are impractical substitutes for various reasons. We report the cases of seven patients in whom anticoagulant therapy was begun with ancrod instead ofheparin for one or more of the following reasons: (1) failure to achieve systemic anticoagulation in response to heparin (e.g., antithrombin III deficiency), (2) heparin-associated complications (e.g., thrombocytopenia, thrombosis, or both), and (3) combined anticoagulation and improved blood theology considered to be potentially more beneficial than anticoagulation alone (e.g., massive thrombosis). In the cases reported, ancrod permitted systemic anticoagulation equal to that of heparin; this was achieved without bleeding complications. In contrast to streptokinase or urokinase, ancrod does not degrade preformed, fiflly cross-linked thrombin fibrin; consequently hemorrhagic complications are uncommon. Ancrod appears to be an appropriate alternative to heparin and may be preferable to it in certain circumstances.

Acute myocardial infarction during coronary angioplasty associated with heparin‐induced thrombocytopenia

“…Ancrod is a defibrogenating agent derived from Malayan pit viper venom. It has no antigenic similarity to heparin, can be easily monitored, and can provide effective anticogulation within 6-1 2 h after intravenous administration [21]. Low molecular weight heparin and heparinoids can be used instead of heparin but only after in vitro testing indicates that a patient's heparin-associated antibody will not cause platelet aggregation in the presence of these agents [22].…”

CABG Without Using Heparin in a Patient With Heparin-Induced Thrombocytopenia

“…It acts fast. Ancrod is used as an alternative drug for heparin and warfarin therapy for (1) failure to achieve systemic anticoagulation (e.g., antithrombin III deficiency), (2) heparin‐associated complications (e.g., thrombocytopenia, thrombosis, or both, and (3) combined anticoagulation and improved blood rheology considered to be potentially more beneficial than anticoagulation alone (e.g., massive thrombosis) 5 . Its effects have not been adequately studied and it is less preferred in cardiac surgery.…”

Die Heparin-induzierte Thrombozytopenie

“…In Einzelfällen wurde über eine erfolgreiche Anwendung von Acetylsalizylsäure (35), des Prostazyklin-Analogons Iloprost (36) oder der Kombination von Iloprost und Acetylsalicylsäure (37) berichtet. Die Defibrinogenierung mit dem Schlangengift Ancrod wurde zur Antikoagulation mit Erfolg eingesetzt (38,39,40), bei Patienten mit HIT wird dieses Vorgehen trotz positiver Kasui-…”