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Case Reports on Emergency Treatment of Cardiovascular Syndromes Through Heparin-Mediated
Low-Density Lipoprotein/Fibrinogen Precipitation: A New Approach to Augment Cerebral
and Myocardial Salvage
Therapeutic Apheresis
2002;6:394-398.
Beate Roxane Jaeger, Eckart Kreuzer, Andreas Knez, Andreas Leber, Peter Überfuhr,
Monika Börner, Petra Milz, Bruno Reichart, Dietrich Seidel
Main strategies for reperfusion treatment of patients with infarctions include two
approaches: coronary angiography/surgical intervention and pharmacological approaches
with antithrombotic drugs. While these approaches have merit, they are limited by:
access to the infarction, a short therapeutic time window, and the risk for serious
complications.
The authors present two case studies in which the heparin-induced method was used
to treat patients presenting at an emergency room with stroke, angina, and myocardial
infarction.
The first case involved a 55-year-old male who suffered a stroke due to occlusion
of the right cerebri media artery. In addition, the patient was disoriented and
had left-side hemiparesis accompanied by hemihyperesthesia and apraxia of the left
arm, central paresis of the facialis nerve, and pronounced dysarthria. Because the
symptoms had begun 2 days prior, thrombolytic therapy was not feasible. The patient
failed to respond to overnight treatment with full-dose heparin and was subsequently
treated with the heparin-induced method. During the 2-hour treatment, the patient
exhibited improved dysarthria. Following apheresis, the patient walked independently,
exhibited improved orientation, and had regained his muscle force. The patient left
the hospital after 1 week with only a slight apraxia of the left hand. At a follow-up
visit the patient reported minor memory problems, which had cleared after 1-month
of treatment.
The second case involved a 60-year-old female who was admitted into the hospital
with chest pain. She reported anginal pain at rest for 3 days, aggravated by an
influenza-like infection with fever and bronchitis. The patient had a history of
severe, diffuse, transplant-associated coronary disease following heart transplantation.
Electrocardiography results and laboratory analysis confirmed myocardial infarction.
Coronary angiography revealed a distal occlusion of the right coronary artery that
was not accessible to intervention. Left ventricular function was reduced but not
quantified. The heparin-induced method had immediate effects, including the disappearance
of anginal pain and a reduction in abnormal heartbeat. Following only 2 hours of
treatment, creatinine kinase (CK) and CK mass dropped by 65% and 72%, respectively.
Apheresis lowered plasma fibrinogen, C-reactive protein, and the global clotting
values. The patient recovered quickly and was discharged after 1 week. No health
problems were reported at 3 months posttreatment.
According to the authors, the positive outcome in both cases show that the heparin-induced
method may be considered an important complementary or alternative approach for
patients experiencing acute cardiovascular events.
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