Subcutaneous heparin for treatment of hypertriglyceridemia-induced pancreatitis

Abstract

I read with great interest the article by Twilla and Mancell1 on the use of insulin and heparin in hypertriglyceridemia-induced acute pancreatitis. Hypertriglyceridemia is the third most common cause of acute pancreatitis in the United States and is associated with considerable morbidity.2 In addition to aggressive hydration and analgesia, the treatment of pancreatitis in such cases should focus on rapid reduction of the serum triglyceride level. Unfortunately, treatment guidelines based on controlled studies are lacking, and clinical experience is limited to case reports. Variable success has been reported with insulin, heparin, plasmapheresis, and antihyperlipidemic medications. Among these treatments, the use of insulin has been the least controversial. It works via modulation of lipoprotein lipase messenger RNA,3 and its action may be slow or inadequate.4 Unfractionated heparin may have a faster effect by releasing endothelial lipoprotein lipase. However, the efficacy and safety of heparin either alone or in combination with insulin in this situation have been a bone of contention.4,5 I describe here the successful treatment of two patients with hypertriglyceridemia-induced pancreatitis with subcutaneous unfractionated heparin.