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Ann Thorac Surg 2003;75:15-16
© 2003 The Society of Thoracic Surgeons

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Editorial

Pork or beef?

^a Departments of Pathology and Molecular Medicine, and Medicine, McMaster University, Hamilton, Ontario, Canada
^b Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada

* Address reprint requests to Dr Warkentin, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, General Site, 237 Barton St E, Hamilton, Ontario L8L 2X2, Canada.

The first 20% of the full text of this article appears below.

Unfractionated heparin is usually obtained from one of two sources: porcine gut or bovine lung. Comparative studies performed in the 1970s of medical patients receiving pork or beef heparin found a much higher frequency of thrombocytopenia in patients who received the beef heparin preparation [1, 2]. However, these studies included all episodes of thrombocytopenia and did not focus on the important patient subgroup with late thrombocytopenia, beginning on or after day 5 of heparin, caused by heparin-dependent, platelet-activating antibodies. Indeed, this syndrome of immune heparin-induced thrombocytopenia (HIT) presents a paradox of anticoagulant-induced thrombosis, as patients with HIT are at high risk for developing venous or arterial thrombosis [3].

During the 1980s, four randomized trials [4–7] were performed that compared the frequency of immune HIT in patients receiving either pork and beef heparin for treatment of acute thrombosis. Although each study was fairly small, their combined results left little doubt that bovine lung heparin was more likely to cause immune HIT: 9 of 152 (5.9%) versus 0 of 154 (0%) patients (p = 0.0059) [8].

With time, unfractionated heparin derived from pork became preferred at many medical centers. . . . [Full Text of this Article]

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