Is there an optimal therapeutical range for low molecular weight heparin? An experimental study.
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Biomedical subjects
Publications and source records attributed to F Doutremepuich.
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Low molecular weight heparins are used in human therapy for preventing venous thrombosis during the postoperative period. The monitoring of this therapy uses a measurement of the factor Xla activity. A value of this activity higher than 0.4 IU/ml, suggests a hemorrhage risk. The use of these low molecular weight heparins for the treatment of venous thrombosis is now under investigation. However, the biological monitoring of this treatment has not yet been defined. The anti IIa and anti Xa activities seem to be interesting. In fact the antithrombotic power would be due to the anti IIa and profibrinolytic activities.
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A randomized study was performed to observe the effects induced by heparin and a low molecular weight heparin fraction (at different dosages) on the leukocytes of rats in the presence of experimental venous thrombosis. The experimentation was carried out on two series of animals: the first with a ligature of the inferior vena cava inducing the formation of a thrombus, the second without any ligature. The results show that the induction of thrombosis involves: in the blood, an increase of the number leukocytes, principally polymorphonuclear cells; in the thrombi, a significant rise in the total count of leukocytes, here mononuclear cells; the latter number increases with the dosages of the administered drugs.
A method to induce microthrombi in small mesenteric arteries (30-40 microns) has been developed to study platelet reactions and to investigate antithrombotic drugs. This model was used to evaluate the effect of Ca-heparin. Mesenteric lesions are induced in the vascular system of Wistar rats with an argon laser. The laser induced the formation of vessel wall lesion with damage of endothelial cells. Thrombi formed within seconds after the laser lesion and grew rapidly. Embolization began within a minute following the laser flash. Thrombus formation and embolization were repetitive phenomena. The administration of Ca-heparin at different dosages (0.5, 1.0 and 2.0 mg/kg) increases the number of laser injuries required to induce thrombus formation, and dose-dependently decreases the number of emboli and the duration of embolization. The highest dose injected (2.0 mg/kg) induced the strongest reduction in the number of emboli and duration of embolization.
Various experimental models have been developed in order to more clearly understand deep vein thrombosis, the mechanisms involved and its treatment. These models are based on venous stasis, either alone or combined with the injection of thrombogenic substances or endothelial lesions. Other models only use endothelial lesions. Thrombogenic substances are mostly composed of activated factor X or thrombin, which raises the problem of purity of the substances and determination of the antithrombotic activities of the substance tested, especially heparin and hirudin and their derivatives, and consequently their efficacy. Endothelial lesions can be induced by chemical, physical or electrical agents or by repeated application of clamps, or cellular crushing. These models result in the formation of various forms of venous thrombus. The development and improvement of experimental models is very important in every case. Experimental models of thrombosis constitute the best tool for the study of thrombosis, in which many points remain to be elucidated. They also allow the study and development of various antithrombotic substances the improvement of their efficacy. These models must be validated, standardized, reproductible and in agreement with local legislation in each country.