- Open Access
Nebulized heparin reduces levels of pulmonary coagulation activation in acute lung injury
Critical Care volume 14, Article number: 445 (2010)
Previously in this journal, we published a phase 1 study of nebulized heparin in patients with acute lung injury . Patients were administered heparin at doses of 50,000, 100,000, 200,000, or 400,000 U/day for 2 days, and bronchoalveolar lavage (BAL) fluid samples were taken at baseline and after the last heparin dose. The study demonstrated a trend to reduced coagulation activation (prothrombin fragments) in BAL fluid after the last dose of nebulized heparin .
Following publication of these data, we were offered the possibility of further analysis of the BAL fluid with additional markers of coagulation activation, including thrombin-antithrombin complexes (TATcs), fibrin degradation products (FDPs), and plasminogen activator activity (PAI-1) levels. We wish to publish the results of this further analysis. The 400,000 U/day group had one patient more than the same group in the previously published data.
We found that TATc and FDP levels were significantly reduced in patients treated with 400,000 U/day of nebulized heparin, but not PAI-1 (Figure 1 overleaf). We believe that these data are important as they demonstrate for the first time that nebulized heparin significantly reduces coagulation activation in the lungs of critically ill patients with acute lung injury. This may be important knowledge as inflammatory mechanisms related to coagulation activation, such as hyaline membrane formation and microvascular thrombosis, may mediate lung injury [2, 3].
fibrin degradation product
plasminogen activator activity
Dixon B, Santamaria JD, Campbell DJ: A phase 1 trial of nebulised heparin in acute lung injury. Crit Care. 2008, 12: R64-10.1186/cc6894.
Dixon B: The role of microvascular thrombosis in sepsis. Anaesth Intensive Care. 2004, 32: 619-629.
Blaisdell FW: Pathophysiology of the respiratory distress syndrome. Arch Surg. 1974, 108: 44-49.
The authors declare that they have no competing interests.
Authors’ original submitted files for images
Below are the links to the authors’ original submitted files for images.
About this article
Cite this article
Dixon, B., Schultz, M.J., Hofstra, J.J. et al. Nebulized heparin reduces levels of pulmonary coagulation activation in acute lung injury. Crit Care 14, 445 (2010). https://doi.org/10.1186/cc9269
- Lung Injury
- Acute Lung Injury