Anesth Analg 2006;102:976
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000199179.25553.A3
LETTER TO THE EDITOR
Vegan? Sorry, We Have Porcine Heparin on the Menu!
Narasimhan Jagannathan, MD
Northwestern University Feinberg School of Medicine, Children's Memorial Hospital, Chicago, IL, simjag2000{at}yahoo.com
To the Editor:
The new wave of vegetarianism has increased the number of vegans in the community. Furthermore, the widespread use of Internet-based search engines has enabled patients to explore aspects of medical care that have historically been hidden from scrutiny.
We recently encountered a patient who was a strict vegan and refused the use of heparin for cardiac surgery because of its porcine origin. We reviewed the available alternatives to heparin (Table 1), most of which are derived from animal sources. The exception is argatroban (1), a synthetic thrombin inhibitor that has been used successfully as an alternative to heparin on cardiopulmonary bypass (2). Argatroban is not as reliable as unfractionated heparin and can pose an increased risk of post-bypass bleeding because it lacks a specific antagonist. After careful discussion of the track record and safety of heparin, as well as the available alternatives, the patient agreed to our using heparin for surgery.
I am also a strict vegetarian, but I would reach the same conclusion: give me heparin until an equivalent alternative is available.
References
- von Segesser LK, Mueller X, Marty B, et al. Alternatives to unfractionated heparin for anticoagulation in cardiopulmonary bypass. Perfusion 2001;16:411–6.[Abstract/Free Full Text]
- Edwards JT, Hamby JK, Worrall NK. Successful use of argatroban as a heparin substitute during cardiopulmonary bypass: heparin-induced thrombocytopenia in a high-risk cardiac surgical patient. Ann Thorac Surg. 2003;75:1622–4.[Abstract/Free Full Text]
