Heparin and Thrombosis: A Seventy Year Long Story

Heparin was a chance discovery made by a medical student who was searching for a clot-promoting activity in various tissue extracts and found an inhibitor of coagulation. It has taken 20 years from the discovery of heparin in 1916 to its therapeutic use (1937). This long delay was mainly due to problems with the purification and extraction on large scale of the active material. Standard unfractionated heparin is a mixture of mucopolysaccharide chains of various length that may range from 5,000 to 30,000 daltons. Heparin is only effective as an anticoagulant in the presence of a plasma protein, termed antithrombin III, with which it forms a complex. High- and low-affinity heparin are two types that readily bind or do not bind to antithrombin III. The pharmacokinetics of unfractionated heparin are compatible with a model based on the combination of a saturable and a linear mechanism. Low-molecular-weight heparins have been produced by a variety of techniques, and their molecular weights range from 3,000 to 9,000 daltons. These preparations have a ratio of anti-Xa activity to anti-II activity of approximately 4, while it is 1 for unfractionated heparin. After intravenous administration of low-molecular-weight heparins, the half-life of the antifactor Xa activity is considerably longer than for unfractionated heparin, while the anti-factor II half-lives are similar. In contrast to unfractionated heparin, low-molecular-weight heparin is virtually completely absorbed after subcutaneous administration, and its biological half-life is almost twice as long. In spite of certain differences with regard to the ratio between factor Xa and Ila inhibition, the various low-molecular-weight preparations show a rather similar absorption pattern. Low-molecular-weight heparins interact less with platelets than unfractionated heparin; nevertheless, a lower bleeding incidence with low-molecular-weight heparin for equivalent antithrombotic efficacy has yet to be established in man.