Assessment of Pleotropic Effect of Heparin Infusion Versus Subcutaneous Injection in Septic Shock Patients
Status:
Recruiting
Trial end date:
2020-12-31
Target enrollment:
Participant gender:
Summary
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep venous thrombosis
(DVT), is a common and severe complication of critical illness. Critically ill patients are
at high risk of VTE because they combine both general risk factors together with specific ICU
risk factors of VTE.Vasopressor administration was found to be an independent risk factor for
DVT. certainly explained by reduced absorption of subcutaneous heparin linked to the
vasoconstriction of peripheral blood vessels. Critically ill patients, due to altered
pharmacokinetics behavior of unfractionated heparin, continuous intravenous infusion of the
low doses of unfractionated heparin has been proposed. Standard prophylaxis with subcutaneous
(SC) heparin is less efficient in patients requiring vasopressors .Sepsis is a systemic
inflammatory response due to an infection. Both inflammatory mediators and coagulation are
involved in sepsis. the release of the inflammatory mediators such as interleukins and tumor
necrosis factor cause damage of the endothelium and activation of coagulation which promotes
inflammatory process .Unfractionated heparin is the most negatively charged biological
molecule known, heparin has a strong ability to interfere with the functioning of positively
charged molecules. Due to the difference in charges, heparin has been documented to interact
with over 100 proteins.57 Interleukins, cytokines, and receptors located on endothelial
cells, which are involved in the acute phase response, are positively charged, and thus are a
reasonable target for the modulating effects of heparin. Heparin has strong anti-inflammatory
effects with many possible mechanisms, including binding to cell-surface glycosaminoglycan's,
preventing leukocyte migration, direct binding to chemokines and cytokines, and inhibition of
intracellular NF-kB .