Comparison of the effect of low molecular weight heparin sodium and that of heparin sodium on pre-disseminated intravascular coagulation stage in patients suffering from exertional heat stroke

Abstract

To study the effect of low molecular weight heparin sodium ( LMWHS ) therapy for exertional heat stroke ( EHS ) patients with pre-disseminated intravascular coagulation ( pre-DIC ). A prospective randomized controlled trial ( RCT ) was conducted. Thirty-six patients with EHS with pre-DIC admitted to Department of Critical Care Medicine of 180th Hospital of Chinese PLA from April 2012 to November 2014 were divided into heparin sodium group ( n = 20 ) and LMWHS group ( n = 16 ) in accordance with the random number table. All patients received bundle treatment after being admitted to the hospital, including rapid cooling, fluid resuscitation, organ support ( mechanical ventilation, hemopurification if necessary ), supplement of pro-coagulation factors, etc. The patients in heparin sodium group were treated with continuous heparin sodium 12 500 U throughout 24 hours with intravenous pump for 5 days, and the patients in LMWHS group were given LMWHS 2 500 U subcutaneously, twice a day for 5 days.The incidence of DIC, incidence of bleeding and mortality of two groups were compared.The platelet count ( PLT ), prothrombin time ( PT ), activated partial thromboplastin time ( APTT ), fibrinogen ( Fib ) and D-dimer of each patient between pre and post treatment times were compared. No significant difference was found in the incidence of DIC and mortality between LMWHS group and heparin sodium group ( 31.2% vs. 30.0%, χ (2) = 0.007, P = 0.936; 6.2% vs. 5.0%, χ (2) = 0.026, P = 0.871 ). Incidence of bleeding during treatment in LMWHS group was significantly lower than that in heparin sodium group ( 12.5% vs. 45.0%,χ (2) = 4.425, P = 0.035 ). After treatment, PLT in both LMWHS group and heparin sodium group was significantly increased compared with that before treatment ( ×10(9)/L: 140.5±17.5 vs. 110.5±16.5, 152.6±21.5 vs. 120.0±20.0, both P < 0.05 ) and D-dimer was significantly decreased ( mg/L: 0.5±0.1 vs. 3.2±1.2, 0.6±0.2 vs. 4.4±1.8, both P < 0.05 ). APTT after treatment in heparin sodium group was significantly prolonged compared with that before treatment ( s: 75.3±10.6 vs. 44.1±8.2, P < 0.05 ) while no change in APTT was found in LMWHS group ( s: 38.6±5.5 vs. 42.1±8.4, P > 0.05 ). No significant difference was found in PT and Fib between pre and post treatment in all the patients. When LMWHS was applied in EHS patients in pre-DIC stage, it could not only prevent DIC as efficiently as heparin sodium, but also results in lower incidence of bleeding. So LMWHS is safer.