Therapeutic Use of Heparin beyond Anticoagulation

Ralf   J.   Ludwig

Abstract

Heparin has been used as an anticoagulant for decades. Recently, attention has been drawn to the nonanticoagulant activities of heparin. Experimentally and clinically those non-anticoagulant properties of heparin inhibit inflammation and metastatic spread of tumor cells. On the molecular level, heparin inhibits the function, expression and/or synthesis of adhesion molecules, cytokines, angiogenic factors and complement. However, despite a similar anticoagulant activity, those non-anticoagulant effects of heparin differ greatly among the different heparin preparations. The same holds true for the most common adverse events of heparin treatment. The incidence of immune mediated heparin-induced thrombocytopenia and cutaneous hypersensitivity responses is greatly, but not exclusively, influenced by the heparin preparation used. As the structure-function relationship of the anti-inflammatory and anti-metastatic effects of heparins are understood in more detail, and as the risk profile of different heparin preparations regarding the induction of adverse events have been identified, we propose to use the different heparin preparations according to the individual needs of each patient.

Keywords: Inflammation, metastasis, heparin, glycosaminoglycans, lymphocyte homing, chemokines, angiogenesis, complement, adverse events