OBJECTIVE: Bacterial sepsis causes widespread vascular inflammation that frequently leads to disseminated intravascular coagulation (DIC). Although intravascular coagulation contributes to organ failure, it is often debated whether anticoagulant therapy produces any beneficial effects in patients with DIC. The aim of this study was to document potential beneficial effects of low molecular weight heparin (LMWH) in a lipopolysaccharide-induced DIC model. DESIGN: Controlled animal experiment combined with an in vitro laboratory study. SETTING: Academic research laboratory. SUBJECTS: C57BL/6 mice subjected to two injections of Serratia Marcescens lipopolysaccharide (LPS) resulting in the generalized Shwartzman's reaction as a model for DIC. INTERVENTIONS: LMWH (5 IU of anti-Xa activity) or saline was administered before both LPS injections and 10 hrs after the first exposure to LPS. To test the effect of LMWH on LPS-driven monocyte inflammatory responses, a human monocyte-human umbilical vein endothelial cell co-culture was used to determine E-selectin expression as a marker of monocyte adherence. MEASUREMENTS AND MAIN RESULTS: In our murine DIC model, LMWH had no effect on markers of inflammation. In addition, no effect of LMWH was detected on monocyte adherence in the human monocyte-human umbilical vein endothelial cell co-culture. Organ damage, contrarily, was significantly reduced as determined by hepatic necrosis (p < .05), lung epithelial protein leakage (p < .05), and creatinine release from kidneys into plasma (p < .01). LMWH protection from organ failure resulted in an increase in survival (p = .06) in this model for DIC. CONCLUSIONS: These results demonstrate the significance of blood coagulation in the progression of DIC and hint at a beneficial role for LMWH anticoagulation in the management of DIC.
|Critical Care Medicine
|Published - 1 Jan 2005