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.Keywords: Trauma, Disseminated intravascular coagulation, Unfractionated heparin, Low-molecularweight heparin, Fibrinogen, Antithrombin
Highlights
Disseminated intravascular coagulation (DIC) secondary to severe trauma, infection, and major surgery is a common fatal disease in the intensive care unit (ICU) [1]
Five deaths occurred in the low-molecular-weight heparin (LMWH) group (19.2 %), six deaths occurred in the unfractionated heparin (UFH) group (24 %), and 15 deaths occurred in the control group (57.7 %)
The DIC scores and prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and levels of antithrombin III (ATIII), D-dimer, and Fg are shown in Tables 1 and 2
Summary
Disseminated intravascular coagulation (DIC) secondary to severe trauma, infection, and major surgery is a common fatal disease in the intensive care unit (ICU) [1]. Other than etiological treatments, hemostatic treatments that supply fibrinogen (Fg), plasma, and blood coagulation factors, as well as plaqueinactivation treatments that involve the infusion of the most common treatments that use UFH or LMWH are more likely to result in a fatal massive hemorrhage, which makes the practicability and safety of these treatments controversial [3]. Based on the results from a small-scale clinical research study [4], we used low-dose UFH and LMWH to treat patients with traumatic DIC in the ICU from June 2007 to February 2010. The effects of anticoagulation treatments that alter ATIII levels in the blood were examined
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