Effect of heparin on secondary brain injury in patients with subarachnoid hemorrhage: an additional ‘H’ therapy in vasospasm treatment

Vasospasm immediately after lower extremity arterial bypass may represent an uncommon cause of early graft failure. We report a successful case of catheter-directed, intra-arterial continuous vasodilator infusion to salvage a bypass graft threatened by severe, refractory vasospasm after incomplete response to nicardipine, verapamil, and nitroglycerin boluses. A continuous nitroglycerin infusion was administered for 24 hours, by which time the vasospasm resolved. At 12 months postoperatively, the graft remained patent with normal results of vascular laboratory studies. This report demonstrates that in cases of refractory vasospasm after peripheral bypass, continuous vasodilator infusion can be an effective treatment to prevent early graft failure.

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“…Also, temporary anticoagulation with a heparin infusion can be considered to prevent graft thrombosis when vasospasm is severe. 21 …”

Section: Discussionmentioning

confidence: 99%

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Magee

Plotkin

Bowser

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…However, the broader role of heparin outside the coagulation cascade argues for a broader utility in aneurysmal SAH. Several clinical studies already suggest that heparin and its low molecular weight derivative enoxaparin reduce the incidence of clinical vasospasm and delayed cerebral infarction following aneurysmal SAH [ 21 , 24 , 72 ], although the literature is not entirely consistent in this result [ 73 ]; a previous review already discussed the role of heparin in the prevention of delayed cerebral ischemia following aneurysmal SAH [ 74 ]. Beyond vasospasm, however, heparin may improve outcomes in aSAH by preventing inflammation and restoring blood-brain barrier integrity.…”

Section: Heparin—physiologic and Pharmacologic Rolesmentioning

confidence: 99%

“…However, heparinization does appear to increase the risk of minor EVD hemorrhage [ 154 ]. In most reports of heparin or its derivatives as a therapeutic modality for vasospasm, hemorrhagic complications are either rare or non-existent [ 21 , 24 , 72 ], although one study noted an increased risk of non-significant bleeding in patients receiving enoxaparin compared to controls [ 73 ]. This low reported risk of hemorrhage is especially striking given the early (less than 12 h) post-operative initiation of heparin in at least one of these studies study [ 21 ].…”

Section: Complications Of Heparin Therapy In Asahmentioning

confidence: 99%

“…Multiple lines of clinical and pre-clinical evidence suggest that the endogenous anti-coagulant heparin effectively reduces inflammation and improves outcomes following aSAH [ 21 , 22 , 23 , 24 ]. Perhaps because of its clinical use as an anti-coagulant and its widely studied interactions with the coagulation cascade, clinicians remain relatively ignorant heparin’s promiscuous interaction with a number of biological processes, especially those involved with inflammation.…”

Section: Introductionmentioning

confidence: 99%

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Heparin and Heparin-Derivatives in Post-Subarachnoid Hemorrhage Brain Injury: A Multimodal Therapy for a Multimodal Disease

et al. 2017

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Pharmacologic efforts to improve outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remain disappointing, likely owing to the complex nature of post-hemorrhage brain injury. Previous work suggests that heparin, due to the multimodal nature of its actions, reduces the incidence of clinical vasospasm and delayed cerebral ischemia that accompany the disease. This narrative review examines how heparin may mitigate the non-vasospastic pathological aspects of aSAH, particularly those related to neuroinflammation. Following a brief review of early brain injury in aSAH and heparin’s general pharmacology, we discuss potential mechanistic roles of heparin therapy in treating post-aSAH inflammatory injury. These roles include reducing ischemia-reperfusion injury, preventing leukocyte extravasation, modulating phagocyte activation, countering oxidative stress, and correcting blood-brain barrier dysfunction. Following a discussion of evidence to support these mechanistic roles, we provide a brief discussion of potential complications of heparin usage in aSAH. Our review suggests that heparin’s use in aSAH is not only safe, but effectively addresses a number of pathologies initiated by aSAH.

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“…Как правило, гепарин-индуцированная тромбоцитопения возникает вследствие введения больших доз высокомолекулярного гепарина и значительной длительности гепаринизации. В настоящее время появляется все больше данных, полученных на людях и животных, свидетельствующих о том, что высокомолекулярный гепарин, используемый в малых и очень малых дозах, достаточно безопасен, очень эффективен и незаменим, особенно при черепно-мозговых травмах, инсультах и аневризмах [14][15][16].…”

Section: Introductionunclassified

Mast Cells Heparin — New Information on the Old Component (Review)

Kondashevskaya

Владиславовна²

2021

Annals RAMS

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Mast cells (MC) are widely distributed throughout the body of animals and humans, mainly in barrier tissues. This review provides new information on the hematopoietic origin of MCs from early erythromyeloid progenitors (EMPs), late EMPs, and definitive hematopoietic stem cells. As well as information on the maturation of MSs and heparin synthesis already in the embryonic period. Many physiological functions of MCs are determined by the properties of heparin, which forms the basis of the matrix of granules, since the heparin molecule is a strong polyanion, capable to forming complexes with many biologically active substances and regulating their properties. In a new hypothesis about the participation of MCs in pathological processes, it is assumed that this is due to the depletion of the heparin pool. In such cases, injections of exogenous heparin can help replenish MCs heparin stores. As a result of the restoration of the physiological functions of MCs and the action of exogenous heparin, the pathological process will be converted into an adaptive one. In clinical practice, unfractionated heparin (UFH) obtained from natural sources and low molecular weight heparin (LMWH) obtained by the biochemical route are used. Most often, UFH and LMWH are used in the clinic only as anticoagulants. The worldwide spread of a disease named COVID-19 in 2020 showed that UFH and LMWH are multifunctional drugs that have saved many people. The pandemic caused by COVID-19 has been an unprecedented social and health emergency worldwide. Depression, anxiety and post-traumatic stress disorder (PTSD) have been reported in populations of many countries. This review provides new information on experimental studies on the successful treatment of pathology with low doses of UFH in modeling PTSD in animals. Consequently, heparin can be considered as a promising multifunctional drug for effective pharmacological correction of comorbid diseases under the influence of extreme factors.

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Effect of heparin on secondary brain injury in patients with subarachnoid hemorrhage: an additional ‘H’ therapy in vasospasm treatment

Cited by 24 publications

References 35 publications

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Successful use of continuous vasodilator infusion to treat critical vasospasm threatening a distal bypass

Heparin and Heparin-Derivatives in Post-Subarachnoid Hemorrhage Brain Injury: A Multimodal Therapy for a Multimodal Disease

Mast Cells Heparin — New Information on the Old Component (Review)

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