Key result
Unfractionated heparin competitively releases heparan sulfate from the endothelial glycocalyx, potentially exposing endothelial cells to inflammatory attack and vascular damage.
This review highlights that unfractionated heparin has complex biological effects beyond anticoagulation, including altering the endothelial glycocalyx, which may contribute to complications associated with cardiopulmonary bypass.
May indicate endothelial risks with unfractionated heparin in bypass; leaves open clinical impact of glycocalyx disruption.
Unfractionated heparin (UFH) is the most widely used injectable medication in the United States. UFH is a poly-dispersed, relatively impure combination of many polysaccharides known as a glycosaminoglycan. It is used as the primary anticoagulant for heart surgery as well as for active treatment of deep venous thrombosis, vascular thrombosis, stroke, and many other potentially catastrophic clotting syndromes. Many perfusionists and cardiac team members know little of the biology of UFH other than its use for cardiopulmonary bypass. UFH is very similar to heparin sulfate, found on the surface of endothelial cells. Heparan sulfate protects endothelial surfaces from inflammatory attack and serves as a mechano-transducer for vascular shear. UFH and all glycosaminoglycans have far reaching pleotropic actions. This review elaborates on some of fascinating unique biology of these polysaccharides. Perhaps a number of the complex complications attributed to CPB are either caused by, or set up to occur by the complicated biology of UFH?
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Bruce D. Spiess (2017) conducted a review in Endothelial dysfunction. Unfractionated heparin was evaluated. Unfractionated heparin competitively releases heparan sulfate from the endothelial glycocalyx, potentially exposing endothelial cells to inflammatory attack and vascular damage.
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