From the FDA Drug Label
Heparin is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans, having anticoagulant properties.
The medication that should be given prophylactically if suspecting mesenteric ischemia is heparin, due to its anticoagulant properties.
- Heparin can help prevent the formation of blood clots that may worsen the condition of mesenteric ischemia. 1
From the Research
For suspected mesenteric ischemia, prophylactic medications should include broad-spectrum antibiotics, anticoagulation, and supportive measures, with a focus on local intra-arterial vasodilator infusion in non-occlusive mesenteric ischemia, as it significantly increases survival rate, as shown in a study published in 2020 2. When suspecting mesenteric ischemia, the following medications should be given prophylactically:
- Broad-spectrum antibiotics, such as a combination of a third-generation cephalosporin (ceftriaxone 1-2g IV every 24 hours) plus metronidazole (500mg IV every 8 hours) or piperacillin-tazobactam (3.375g IV every 6 hours), to provide empiric coverage against gut flora translocation.
- Anticoagulation with unfractionated heparin (80 units/kg IV bolus followed by 18 units/kg/hour infusion, adjusted to maintain aPTT 1.5-2.5 times normal) to prevent further thrombosis and potentially improve perfusion.
- Local intra-arterial papaverine infusion therapy, as it has been shown to significantly increase survival rate in patients with non-occlusive mesenteric ischemia, with a hazard ratio of 2.44 and a p-value of 0.005, compared to conservative treatment 2.
- Supportive measures, including adequate fluid resuscitation with isotonic crystalloids to maintain hemodynamic stability and tissue perfusion, and pain management with opioid analgesics if necessary. It is essential to avoid vasopressors if possible, as they can worsen splanchnic vasoconstriction, and to arrange urgent diagnostic studies and surgical consultation, as definitive treatment often requires revascularization or resection of necrotic bowel, with early intervention being critical to prevent high mortality rates and intestinal infarction.