Hospitals at risk of suspending heart surgeries due to medication shortage

Nguyen Sinh Hien, director of Hanoi Heart Hospital, said the hospital will use up its protamine sulfate in a few more weeks and in case new orders do not arrive in time, the hospital would have to halt heart surgeries.

Protamine sulfate is a medication that is used to reverse the effects of heparin, which is used to prevent blood clotting during open-heart surgery, bypass surgery, kidney dialysis, and blood transfusions.

Hien said several other hospitals in Hanoi had also run out of protamine sulfate, which is irreplaceable in heart surgeries, and have had to borrow from other hospitals.

He said for a typical heart operation, patients use up about three ampoules of protamine sulfate and the hospital consumes about 600-700 tubes per month.

Due to a lack of this medicine, the hospital is reducing the number of surgeries and prioritizing only life-threatening cases.

Hanoi Heart Hospital had planned to acquire this drug, which is currently out of supply.

This is a drug that Vietnam cannot yet produce and so far, there has been just a few pharmaceutical companies that import and distribute it in the country, as approved by the Health Ministry’s Drug Administration.

“The hospital cannot do anything but wait,” Hien said, adding that the hospital also lacks several drugs but they can be replaced by others.

In recent times, some hospitals have used Prosulf, which can also counteract the anticoagulant effect of heparin, as a replacement.

However, the medicine cannot be used for children and for adults, it cannot be used for certain cases as it can cause anaphylaxis, hypotension or cardiac arrest. Yet this drug is also out of stock.

A representative of HCMC’s Cho Ray, the biggest public general hospital in southern Vietnam, said the facility still has about 300 tubes of protamine sulfate, while its monthly demand is about 500 tubes.

Recently, the hospital has applied for a quota of 2,800 ampoules of Prosulf, but there are no participating bidders.

“Normally the approval process can exceed two months, while the drug only lasts less than a month,” the representative said.

Cho Ray Hospital is considering borrowing the medicine from other medical facilities.

An unnamed cardiovascular surgeon at a major hospital in HCMC said the hospital only has two tubes of protamine sulfate for surgery on children. Prosulf alone is only enough to last about one or two weeks.

“If we run out of the medicine and we can’t borrow from another hospital, we have only one option left: suspend operations,” the doctor said.

Nguyen Quynh Hoa, head of the drug department at Hanoi’s Bach Mai Hospital, one of the largest public facilities in Vietnam, said the hospital still has enough medicine for about a month.

In order to maintain enough drugs for surgery, Bach Mai is “rushing” to restock, she said.

Shortages of drugs and medical supplies have swept hospitals across the nation. Many facilities have lacked antibiotics to treat severely ill patients, narcotic drugs, psychotropic drugs, cardiovascular drugs, those for hypertension, and anti-inflammatory drugs, for several months.

The reason for the shortage is partly due to the expiration of the circulation registration numbers of some drugs, a severe shortage of state management personnel, and difficulties in processing dossiers, it has been reported.

The delay is also attributed to national centralized bidding and drug price negotiations. Some localities have assigned hospitals to organize bids on their own rather than rely on centralized bidding, but the hospitals have been fearful of this, resulting in a drug shortage.

Several health officials and hospital leaders have said that complicated bidding procedures and low financial capacity after two years of Covid-19 were major reasons for the current supply crisis.

At the seminar on solutions to overcome drug shortages held Friday in Hanoi, Nguyen Huy Quang, former head of legal department under the Ministry of Health, said there is currently a disruption in the global drug supply chain and in addition, with the pandemic under control, people have flocked to hospitals to have their health checked and their conditions treated, contributing to the drug shortage.

The Ministry of Health had last week formed teams to inspect the current supply and use of medicine, as well as survey drug and medical supply shortages across the country.