The role of heparin and allied compounds in the treatment of sepsis

Alexander D. Cornet; Ellen G. M. Smit; Albertus Beishuizen; A. B. Johan Groeneveld

doi:10.1160/TH07-01-0006

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2007; 98(03): 579-586
DOI: 10.1160/TH07-01-0006

Review Article

Schattauer GmbH

The role of heparin and allied compounds in the treatment of sepsis

Alexander D. Cornet

¹Department of Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

,

Ellen G. M. Smit

¹Department of Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

,

Albertus Beishuizen

¹Department of Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

,

A. B. Johan Groeneveld

¹Department of Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

› Institutsangaben

Abstract

Summary

The crosstalk between coagulation and inflammation and the propensity for microthromboembolic disease during sepsis calls for anticoagulant measures to prevent tissue hypoxygenation and to attenuate organ damage and dysfunction. Only one anticoagulant, recombinant human activated protein C (aPC, drotrecogin-α) has a proven survival benefit when used as an adjunctive therapy for human sepsis, partly because of its anti-inflammatory effect. However, heparin (-like compounds) may exert similar beneficial anti-inflammatory actions as aPC, in spite of the relatively narrow therapeutic window for anticoagulation. This narrative review is based on a Medline search of relevant basic and clinical studies published in English and discusses the potential role of heparin in modulating inflammatory responses in the treatment of animal models and human sepsis and its harmful sequelae. In any case, the results of a metaanalysis based on animal data suggest a potentially life-saving effect of heparin (-like compounds) in the treatment of sepsis.Therefore, a prospective randomized clinical trial is called upon to study effects in human sepsis.

Keywords

Heparin - sepsis - disseminated intravascular coagulation - cytokines - host defence - aPC - survival - inflammation

Volltext

Referenzen

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