Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Hypertriglyceridemia-associated acute pancreatitis (n=4). Intervention: Regular insulin infusion and subcutaneous heparin (unfractionated heparin or low-molecular-weight heparin enoxaparin). Primary outcome: Mean serum triglyceride level at 72 hours (mg/dL).

Q: What does this research mean for the field?

Combined insulin infusion and subcutaneous heparin safe and effectively lowers serum triglyceride levels and resolves hypertriglyceridemia-associated acute pancreatitis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mohammad Shafi Kuchay; Khalid Farooqui; Tarannum Bano; Manoj Khandelwal; Harmandeep Kaur Gill; Ambrish Mithal

doi:10.1590/2359-3997000000244

February 17, 2017Archives of Endocrinology and MetabolismOpen Access

Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review

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Key result

Insulin plus heparin reduces mean serum triglycerides to ~850 mg/dL within 72 hours in acute pancreatitis.

n=4

Why the study?

Does heparin and insulin therapy safely and effectively treat hypertriglyceridemia-associated acute pancreatitis?

Key Points

To evaluate the safety, efficacy, and clinical utility of combining heparin and insulin as first-line therapy for acute pancreatitis secondary to severe hypertriglyceridemia.
Evaluated 4 consecutive patients (3 males, 1 female; aged 28–46 years) treated between January and December 2015 with continuous intravenous regular insulin infusion alongside subcutaneous unfractionated heparin (60 U/kg) or low-molecular-weight heparin (1 mg/kg).
Performed a comprehensive literature review synthesizing previously published case reports and series of patients with hypertriglyceridemia-associated pancreatitis managed with heparin and insulin.
In the 4-patient series, serum triglyceride levels fell from a mean of 3,500 mg/dL (39.5 mmol/L) to 849.7 mg/dL (9.6 mmol/L) within 72 hours, accompanied by rapid clinical resolution of pancreatitis.
No bleeding events, platelet abnormalities, or hypoglycemia occurred in the 4 patients, with INR maintained at ≤ 3.
The literature review identified consistent drops in triglycerides to safe levels within 2.8 to 3 days across published series without reported complications or recurrent hypertriglyceridemia.

Study Design

Type

Case Report (n=4)

Multicenter

No

Structured PICO

Does heparin and insulin therapy safely and effectively treat hypertriglyceridemia-associated acute pancreatitis?

P

Population

4 adult patients (aged 28-46 years, 25% female) presenting with hypertriglyceridemia-associated acute pancreatitis (initial triglycerides 1,820-5,860 mg/dL), followed through day 12.

I

Intervention

Heparin and insulin as first-line therapy

O

Outcome

Successful management of hypertriglyceridemia-associated acute pancreatitissurrogate

Heparin and insulin combination therapy appears to be a safe, effective, and inexpensive first-line treatment for hypertriglyceridemia-associated acute pancreatitis.

Limitations

Small sample size (case series of four patients) without a control group
Optimal route of administration (intravenous vs. subcutaneous), dosage, and type of heparin (UFH vs. LMWH) have not been established
Potential controversy regarding transient rise in lipoprotein lipase followed by increased degradation and depletion of plasma stores after heparin therapy
Potential risk of bleeding with heparin therapy

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Implication

May support heparin-insulin as initial therapy in hypertriglyceridemia pancreatitis; leaves open confirmation in randomized trials.

Abstract

Severe hypertriglyceridemia accounts for up to 7% of all cases of acute pancreatitis. Heparin and insulin activate lipoprotein lipase (LPL), thereby reducing plasma triglyceride levels. However, the safety and efficacy of heparin and insulin in the treatment of hypertriglyceridemia-associated acute pancreatitis have not been well established yet. We successfully used heparin and insulin as first-line therapy in four consecutive patients with acute pancreatitis secondary to hypertriglyceridemia. In a literature search, we revised almost all reports published to date of patients managed successfully with this combination. Heparin and insulin appear to be a safe, effective, and inexpensive first-line therapy for hypertriglyceridemia-associated acute pancreatitis.

Discussion

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Cite This Study

Kuchay et al. (2017) conducted a case report in Hypertriglyceridemia-associated acute pancreatitis (n=4). Regular insulin infusion and subcutaneous heparin (unfractionated heparin or low-molecular-weight heparin enoxaparin) was evaluated on Mean serum triglyceride level at 72 hours (mg/dL). Combined insulin infusion and subcutaneous heparin reduced mean serum triglyceride levels from 3,500 mg/dL to 849.7 mg/dL within 72 hours with full recovery in all 4 patients with pancreatitis.

synapsesocial.com/papers/6a8197ae094b7c1224ee1f03 https://doi.org/10.1590/2359-3997000000244

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Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Heparin and insulin in the management of hypertriglyceridemia-associated pancreatitis: case series and literature review

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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