Düşük doz fraksiyone olmayan heparin ve düşük moleküler ağırlıklı heparinin farelerde subaraknoid kanama sonrası erken beyin hasarı üzerindeki etkileri

Amaç: Kapsamlı araştırma çabalarına rağmen, subaraknoid kanama sonrası erken beyin hasarını (EBI) önlemek için kanıtlanmış etkili bir tedavi yoktur. Heparin, birçok patofizyolojik mekanizmayı antagonize eden pleiotropik bir ilaçtır. Bu çalışmada, heparinin subaraknoid kanama (SAK) sonrası erken beyin hasarını (EBH) önleyip önlemediğini değerlendirdik. Yöntem: SAK, farelerde endovasküler perforasyonla indüklendi ve hayvanlar Kontrol (n = 8), SAK (n=12), SAK + 10U UFH (n=11), SAK + 40U UFH (n=13), SAK + 4U dalteparin (n=11) ve SAK + 16U dalteparin (n=14) olarak gruplara ayrıldı. SAK’dan 24 saat sonra subaraknoid kanama ciddiyeti, mortalite, nörolojik skor ve beyin su içeriği değerlendirildi. Bulgular: Düşük doz fraksiyone olmayan heparin (UFH) ile düşük doz düşük moleküler ağırlıklı heparin (LMWH)’in beyinde subaraknoid kanama miktarında bir değişiklik olmadığı ve nörolojik muayenede, beyin su içeriğinde erken dönemde iyileştirme yaptığı, mortaliteyi sayısal olarak azalttığı belirlenmiş ancak istatistiksel olarak birbirine üstünlüğü görülmemiştir. Yüksek doz fraksiyone olmayan heparin (UFH) veya düşük moleküler ağırlıklı heparin (LMWH) nöroprotektif

Effects of low-dose unfractionated heparin and low molecular weight heparin on early brain injury after subarachnoid hemorrhage in mice

Objective: Despite extensive research efforts, there is no proven effective treatment to prevent early brain damage (EBI) after subarachnoid hemorrhage. Heparin is a pleiotropic drug that antagonizes many pathophysiological mechanisms. In this study, we evaluated whether heparin prevents early brain damage (EBI) after subarachnoid hemorrhage (SAH). Methods: SAH was induced by endovascular perforation in mice and animals devided into 6 groups; Control (n = 8), SAH (n = 12), SAH + 10U UFH (n = 11), SAH + 40U UFH (n = 13), SAH + 4U dalteparin (n = 11) and SAK + 16U dalteparin (n = 14). Subarachnoid hemorrhage severity, mortality, neurological score and brain water content were evaluated at 24 hours after SAH. Results: It was found that low-dose unfractionated heparin (UFH) and low-dose low molecular weight heparin (LMWH) decreased brain water content, improved neurological score and did not increase subarachnoid hemorrhage amount in the early period of SAH. It was observed that it decreased mortality numerically, however it was not observed statistically superioriority to each other. It has been shown that high-dose unfractionated heparin (UFH) or high-dose low molecular weight heparin (LMWH) inhibits the neuroprotective effects, creating a tendency to increase subarachnoid hemorrhage and increase brain damage by activating other mechanisms. Conclusion: Low-dose unfractionated heparin (UFH) and low-dose low molecular weight heparin (LMWH) treatment in the early period after SAH may reduce early brain injury and clinically imply that it may be effective for the early prevention of secondary brain injury after acute aneurysm rupture.

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