Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System

Recently the heparin supply in 12 countries was found to be contaminated with a substance that caused hypotension and, in some cases, death. The contaminant has been identified as oversulfated chondroitin sulfate (OSCS). This study shows that OSCS can activate the kinin–kallikrein pathway and the complement system, which can result in the clinical syndrome. Recently the heparin supply in 12 countries was found to be contaminated with a substance that caused hypotension and, in some cases, death. This study shows that the contaminant, oversulfated chondroitin sulfate (OSCS), can activate the kinin–kallikrein pathway and the complement system, which can result in the clinical syndrome. In January 2008, health authorities in the United States began receiving reports of clusters of acute hypersensitivity reactions in patients undergoing dialysis that had been occurring since November 2007. Symptoms included hypotension, facial swelling, tachycardia, urticaria, and nausea. Although initial investigations focused on dialysis equipment, an investigation by the Centers for Disease Control and Prevention identified the receipt of heparin sodium for injection (1000 U per milliliter, in 10-ml and 30-ml multidose vials), manufactured by Baxter Healthcare, as a common feature of the cases. 1 This finding led Baxter Healthcare to recall, on January 17, 2008, nine lots of heparin sodium . . .