heparitin-sulfate and Gastrointestinal-Hemorrhage

We report the second case of an acquired heparin-like anticoagulant in a patient with disseminated breast carcinoma. All but one of the small numbers of other cases have also been associated with an underlying malignancy. We comment on the distinction between an immunoglobulin and proteoglycan causing the antithrombin effect and suggest points of interest for consideration in any future cases together with a review of treatment options.

Topics: Anticoagulants; Blood Coagulation Disorders; Breast Neoplasms; Female; Gastrointestinal Hemorrhage; Heparin; Heparitin Sulfate; Humans; Middle Aged; Thrombin Time

In a randomised cross-over study we assessed total blood loss in 14 dialysis patients using 59Fe as a marker for measurement in a whole-body counting system. In one period the patients received standard heparin, in the other ORG 10172, a new low-molecular-weight-heparinoid. Our results show no significant difference between the two study periods with regard to blood loss and dialyser blood retention. In some patients a delayed bleeding ('oozing') from the puncture site was noticed as a side-effect of treatment with the low-molecular-weight-heparinoid. We conclude that this heparinoid is effective as an anticoagulant in regular dialysis treatment, but it seems to have no advantage over standard heparinisation with regard to occult bleeding. This may be related to the prolonged plasma anti-Xa activity (30.8 h) of this compound compared to standard heparin in dialysis patients.

Topics: Adult; Chondroitin Sulfates; Dermatan Sulfate; Female; Gastrointestinal Hemorrhage; Glycosaminoglycans; Heparin; Heparinoids; Heparitin Sulfate; Humans; Male; Middle Aged; Renal Dialysis

A 54-year-old man had been admitted to Nara city hospital because of hematemesis and dyspnea caused by physical exertion, and was given a diagnosis of esophago-cardial varices and portal venous thrombosis. He was transferred to our hospital for further examinations and treatments. Ultrasonography (US) and computed tomography (CT) revealed the progression of portal venous thrombosis. Danaparoid sodium was administered to treat the portal vein thrombus. 5 days later, the patient was found to have hematemesis resulting from a cardial varices rupture. After endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) was performed, danaparoid sodium was administered for 2 weeks. After the treatment, portal vein thrombus had almost disappeared. Due to an increased risk of bleeding, cases of esophago-cardial varices with portal venous thrombosis must be treated with care. This is the first report of upper gastrointestinal bleeding due to danaparoid sodium. Danaparoid sodium must be carefully administered when patients have portal venous thrombosis with delicate varices.

Topics: Anticoagulants; Chondroitin Sulfates; Dermatan Sulfate; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hematemesis; Heparitin Sulfate; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Portal Vein; Sclerotherapy; Venous Thrombosis

Bacterial infections have been postulated as a trigger for variceal bleeding in cirrhotic patients, and impair coagulation evaluated by thrombelastography (TEG). Endogenous heparinoids have been detected after variceal bleeding and during liver transplantation in some cirrhotics using heparinase-modified-TEG.. To assess if bacterial infection is associated with endogenous heparinoids in cirrhotics, thus impairing coagulation.. Native and heparinase-modified-TEG (cleavage of heparin and heparan-sulphate) was performed in 60 cirrhotics (Grade A, 2; B, 30; C, 28): 30 infected [septicaemia, 6 (culture positive); 6 (culture negative); spontaneous bacterial peritonitis, 10; chest infection, 4; others, 4], 30 not infected, and five infected patients without liver diseases, comparing TEG parameters r, alpha, and ma. Eight cirrhotics were studied before and after infection. The diagnosis of presence and type of infection was based on international standard criteria.. A significant heparin effect was found only in infected cirrhotics (28 of 30) with significant changes in r (P=0.0003), alpha (P<0.0001), and ma (P<0.0001), but in none of those not infected. This effect completely reversed in the eight evaluated after resolution of infection. There was no heparin effect in infected non-cirrhotics.. A heparin effect was only found in cirrhotic patients with infection, further confirming that infection significantly modifies coagulation in cirrhotic patients.

Topics: Adult; Bacterial Infections; Blood Coagulation; Female; Gastrointestinal Hemorrhage; Heparin; Heparin Lyase; Heparinoids; Heparitin Sulfate; Hepatitis, Chronic; Humans; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Thrombelastography

Bleeding as a complication of liver disease can occur in the absence of recognised haemostatic defects. It is now possible to measure the concentration of endogenous heparinoid substances in the blood using a competitive binding assay. One such substance, heparan sulphate (normal range < 600 ng/ml) was assayed in the plasma of 49 patients admitted because of oesophageal varices. In 27 patients with recent upper gastrointestinal bleeding the median plasma heparan sulphate value was 1700 ng/ml (interquartile (IQ) range 900-3900) compared with 390 ng/ml (IQ range 256-800) in 22 patients with no recent bleed (p < 0.01). As heparan sulphate is metabolised by the same route as exogenous heparin, an attempt to establish a cause for the raised heparan concentrations was made by measuring the clearance of exogenous heparin in 10 portal hypertensive patients and 10 controls. The median half life of heparin in plasma in the portal hypertensive patients (25.5 minutes; IQ range 22-34) was significantly longer (p < 0.007) than the median half life in the controls (18.7 minutes; IQ range 17-21.5). Thus, there is evidence of raised concentrations of endogenous heparin like substances in portal hypertensive patients after gastrointestinal bleeding. These high concentrations may result from reduced hepatic clearance.

Topics: Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Half-Life; Heparin; Heparitin Sulfate; Humans; Hypertension, Portal; Male; Middle Aged