heparitin-sulfate and Arterial-Occlusive-Diseases

The aim of this study has been to assess the efficacy and the safety of heparansulphate administered with indobufen in the treatment of occlusive arterial disease.. In a controlled open study, nineteen out-patients with Fontaine's stage II occlusive arterial disease since one year were randomly assigned to treatment with indobufen 200 mg/day or indobufen 200 mg/day and heparansulphate 200 mg/day for 6 months. Efficacy assessments were based on functional evaluations (pain-free sub-maximal exercise ergometric test, ankle-arm pressure ratio at rest and after induced ischemia), on hemocoagulative parameters and on physical signs and subjective symptoms assessed monthly over the whole period of treatment. All patients but one who was lost to follow-up completed the study treatment period as foreseen by the experimental protocol.. The results of the study show an improvement of 10.89% (day 30), 15.92% (day 60), 21.04% (day 90), 24.19% (day 120), 25.18 (day 150) 28.84% (day 180) end of study in ergometric test pain-free interval obtained by patients treated with heparansulphate and indobufen with respect to patients receiving indobufen alone. Also hemocoagulative parameters and signs and patients' subjective symptoms were positively influenced by the association heparansulphate and indobufen.. On the whole, the results of the study indicate that heparansulphate in association with antiplatelet therapy with indobufen has a beneficial effect in the treatment of peripheral occlusive arterial disease.

Topics: Adult; Aged; Arterial Occlusive Diseases; Female; Heparitin Sulfate; Humans; Intermittent Claudication; Isoindoles; Leg; Male; Middle Aged; Phenylbutyrates; Platelet Aggregation Inhibitors

Type II of heparin-associated thrombocytopenia (HAT) is well known, but the cardinal symptom, thrombocytopenia, is rarely adequately considered. Serious and potential lethal complications such as pulmonary embolism, cerebral stroke, or limb gangrene are often falsely regarded as insufficient anticoagulation. Guided diagnosis and therapy are of vital importance for the patient's outcome. Based on the experience of patients with HAT Type II treated in the intensive care unit, a diagnostic and therapeutic approach to the cardinal symptom thrombocytopenia is presented. A recently developed heparin-induced platelet activation assay (HIPAA) seems to be a highly sensitive laboratory test. The first therapeutic principle in case of presumed and diagnosed HAT is the cessation of unfractioned or low-molecular-weight heparins. ORG 10172 (Orgaran), a low-sulfated heparinoid with a low cross-reactivity (10%) to heparins, can be regarded as the most effective anticoagulant in patients with HAT Type II.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arterial Occlusive Diseases; Chondroitin Sulfates; Dermatan Sulfate; Diagnosis, Differential; Female; Gangrene; Heparin; Heparitin Sulfate; Humans; Middle Aged; Phenprocoumon; Platelet Activation; Platelet Aggregation; Platelet Count; Pulmonary Embolism; Recurrence; Systemic Inflammatory Response Syndrome; Thrombocytopenia; Thromboembolism; Thrombophlebitis

The effect of a 60 day administration of 200 mg heparan sulfate (Hemovasal 100 b.i.d.) or 100 mg mesoglycan (50 mg b.i.d.) was assessed under double blind design in forty patients (thirty-six males and four females) with peripheral occlusive arterial disease with respect to pain-free walking distance and various haemorheological and haemostasiological variables, platelet aggregation and blood chemistry. The pain-free walking distance significantly improved with heparan sulfate (up 67% from baseline 200.0 +/- 22.5 m and up 34%, with mesoglycan from baseline 207.7 +/- 23.4 m). Heparan sulfate significantly stimulated fibrinolysis and reduced platelet aggregability: these findings suggest an action of heparan sulfate on the endothelial cells, thus reducing their thrombogenicity. The results of the study thus confirm the activity of heparan sulfate in peripheral vascular disease, correcting the conditions which constitute the basis of increased thrombotic risk.

Topics: Aged; Arterial Occlusive Diseases; Blood Coagulation; Double-Blind Method; Female; Fibrinolysis; Glycosaminoglycans; Hemostasis; Heparitin Sulfate; Humans; Leg; Male; Middle Aged; Platelet Aggregation; Platelet Aggregation Inhibitors; Walking

Acute graft thrombosis is a severe complication in vascular surgery that may require limb amputation or even cause death. Because nearly all patients undergoing vascular surgery have had previous exposure to heparin, the presence of heparin-related anti-platelet antibodies typical for heparin-associated thrombocytopenia (HAT) is one underlying possible mechanism of acute graft thrombosis. Although thrombocytopenia is a typical finding of HAT, it is not clear whether the occurrence of clinically important HAT is necessarily associated with thrombocytopenia.. Ten out of 246 patients undergoing vascular surgery were diagnosed with HAT because of otherwise unexplained acute graft thrombosis that required recurrent surgical interventions.. In all of the 10 patients, heparin-related anti-platelet antibodies were detected although the platelet counts were within the normal range. When HAT was diagnosed, heparin administration was stopped and, after autoantibody cross-reactivity with the heparinoid Danaparoid had been excluded, anticoagulation was continued using this anticoagulant. After heparin therapy was discontinued none of the 10 patients developed further thrombotic complications.. The data presented demonstrate clearly that a normal platelet count does not exclude the possibility of HAT. As a consequence of this, HAT should be suspected in patients who develop thrombotic complications during heparin treatment, regardless of the actual platelet counts.

Topics: Adult; Aged; Anastomosis, Surgical; Arterial Occlusive Diseases; Autoantibodies; Blood Platelets; Blood Vessel Prosthesis; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Female; Graft Occlusion, Vascular; Heparin; Heparinoids; Heparitin Sulfate; Humans; Intraoperative Complications; Male; Middle Aged; Platelet Count; Reoperation; Thrombosis; Vascular Patency