Heparin Resistance Induced by Intravenous Nitroglycerin: A Word of Caution When Both Drugs Are Used Concomitantly

doi:10.1001/archinte.1987.00370050053009

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Vol. 147 No. 5, May 1987

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Heparin Resistance Induced by Intravenous Nitroglycerin

A Word of Caution When Both Drugs Are Used Concomitantly

Moh'd A. Habbab; Jacob I. Haft, MD

Arch Intern Med. 1987;147(5):857-860.

Abstract

• Intravenous (IV) nitroglycerin was found to interferewith the anticoagulant effect of heparin during eight infusionsof both drugs in seven patients who were closely monitored withfrequent activated partial thromboplastin time determinations.All patients were resistant to heparin when receiving IV nitroglycerinand had a marked increase in sensitivity when discontinuingthe IV nitroglycerin therapy. This effect was present whetheror not propylene glycol was in the preparation. Patients treatedwith simultaneous IV nitroglycerin and IV heparin must be monitoredoften to avoid inadequate anti-coagulation, and heparin dosageshould be decreased when stopping IV nitroglycerin therapy toavoid hemorrhage.

(Arch Intern Med 1987;147:857-860)

Author Affiliations

From the Department of Cardiology, St Michael's Medical Center, Newark, NJ.

Footnotes

Accepted for publication Sept 29, 1986.

Reprint requests to Department of Cardiology, St Michael's MedicalCenter, 268 Dr Martin Luther King Jr Blvd, Newark, NJ 07102(Dr Haft).

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