Effects of low-molecular-weight heparin and unfractionated heparin on traumatic disseminated intravascular coagulation

Abstract

Purpose: To explore the effects of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) on traumatic disseminated intravascular coagulation (DIC). Methods: A total of 77 cases of severe trauma (APACHE II score: 5-10) with DIC were collected and randomly assigned to one of three groups: LMWH treatment-26 cases were subcutaneously injected with LMWH (75-150 units/kg/d); UFH treatment-25 cases were subcutaneously injected with UFH (100-250 units/kg/d); control-26 cases supplemented with blood coagulation factor only. Daily mortality in the intensive care unit (ICU), hospitalization time, bleeding rate, thrombin time, prothrombin time, activated partial thromboplastin time, and levels of fibrinogen, antithrombin III (ATIII), and D-dimer were recorded and analyzed. Results: In ICU, LMWH and UFH treatments resulted in lower mortality than in the control group. In addition, hospitalization time was longer in patients treated with LMWH and UFH than in control patients. No significant differences were found between LMWH-treated and control patients in terms of bleeding rate, but UFH-treated patients had lower bleeding rates than control patients. Multifactor analysis indicate a strong relationship between ATIII levels and bleeding rate. Conclusion: The results indicate that low-dose UFH and LMWH are effective options for the treatment of DIC.

The Effect of Heparin and Its Preparations on Disseminated Intravascular Coagulation Mortality and Hospitalization: A Systematic Review

“…Patients were diagnosed by the ISTH criteria and divided into three groups, treated by heparin ( n = 25), LMWH ( n = 26), and “coagulation factors only” as a control group ( n = 26). Results showed a significant difference in mortality rate in the control group in comparison with the two treatment groups and no substantial difference was observed between heparin and LMWH groups (57.7% control, 19.2% LMWH, and 24% heparin) [ 13 ]. In another clinical trial, the effect of heparin was analyzed in the treatment of newborn infants with respiratory distress syndrome and DIC.…”

“…In two RCT studies, the effect of LMWH was investigated alone or with heparin in separate groups. Interestingly, both of them demonstrated that heparin and its preparations have a significant effect on the reduction of mortality rate in DIC patients [ 9 , 13 ]. Sakuragawa et al reported a 7.8% mortality rate in heparin group and no mortality was observed in the LMWH group.…”

“…However, there was no significant difference between groups [ 9 ]. Another clinical trial stated a significant difference in mortality rate between control group and LMWH-heparin group [ 13 ]. According to these two RCTs, heparin and its preparations can reduce mortality rate in DIC patients due to their exceptional mechanisms through inhibition of thrombin and reducing coagulation disorder.…”

“…Wen et al have investigated the effect of heparin and low-molecular-weight heparin (LMWH) separately against control group on traumatic disseminated intravascular coagulation. They reported a significant difference in mortality rate in control group in comparison with treatment groups [ 13 ]. Also, in a study by Ning et al, the impacts of heparin and LMWH on patients infected with coronavirus and high risk of DIC were evaluated.…”

Ascidian-Inspired Heparin-Mimetic Magnetic Nanoparticles with Potential for Application in Hemodialysis as Recycling Anticoagulants

“…Generally, APTT is used to measure the inhibition efficacy of both intrinsic and common coagulation pathways, and TT is used to measure the clot formation time for fibrinogen being converted into fibrin by thrombin . In this study, HLSA acted as a heparinized material because of the heparin-mimetic groups.…”