Heparin and heparin-derivatives in post-subarachnoid hemorrhage brain injury: A multimodal therapy for a multimodal disease
MetadataShow full item record
AbstractPharmacologic efforts to improve outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remain disappointing, likely owing to the complex nature of post-hemorrhage brain injury. Previous work suggests that heparin, due to the multimodal nature of its actions, reduces the incidence of clinical vasospasm and delayed cerebral ischemia that accompany the disease. This narrative review examines how heparin may mitigate the non-vasospastic pathological aspects of aSAH, particularly those related to neuroinflammation. Following a brief review of early brain injury in aSAH and heparin's general pharmacology, we discuss potential mechanistic roles of heparin therapy in treating post-aSAH inflammatory injury. These roles include reducing ischemia-reperfusion injury, preventing leukocyte extravasation, modulating phagocyte activation, countering oxidative stress, and correcting blood-brain barrier dysfunction. Following a discussion of evidence to support these mechanistic roles, we provide a brief discussion of potential complications of heparin usage in aSAH. Our review suggests that heparin's use in aSAH is not only safe, but effectively addresses a number of pathologies initiated by aSAH.
SponsorsThis work was supported by grants to JMS from the National Institute of Neurological Disorders and Stroke (NS060801; NS061808) and the National Heart, Lung and Blood Institute (HL082517).
Identifier to cite or link to this itemhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85020187412&doi=10.3390%2fmolecules22050724&partnerID=40&md5=6d6817a76d8cb4583136a3c7ec593f09; http://hdl.handle.net/10713/11127
- The incidence of heparin-induced thrombocytopenia Type II in patients with subarachnoid hemorrhage treated with heparin versus enoxaparin.
- Authors: Kim GH, Hahn DK, Kellner CP, Komotar RJ, Starke R, Garrett MC, Yao J, Cleveland J, Mayer SA, Connolly ES
- Issue date: 2009 Jan
- Heparin Treatment in Aneurysmal Subarachnoid Hemorrhage: A Review of Human Studies.
- Authors: Khattar NK, Bak E, White AC, James RF
- Issue date: 2020
- Effect of heparin on secondary brain injury in patients with subarachnoid hemorrhage: an additional 'H' therapy in vasospasm treatment.
- Authors: Bruder M, Won SY, Kashefiolasl S, Wagner M, Brawanski N, Dinc N, Seifert V, Konczalla J
- Issue date: 2017 Jul
- The role of immune inflammation in aneurysmal subarachnoid hemorrhage.
- Authors: Zeyu Zhang, Yuanjian Fang, Cameron Lenahan, Sheng Chen
- Issue date: 2020 Nov 26
- Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment.
- Authors: Simard JM, Aldrich EF, Schreibman D, James RF, Polifka A, Beaty N
- Issue date: 2013 Dec