Monday August 7, 2006
rhAPC (Xigris) and low-dose heparin in septic shock


Interesting laboratory work from New York, published this month in Critical Care Medicine issue 1, regarding possible interaction of rhAPC (recombinant human activated protein C) and low dose heparin. Following preparation was made in 3 steps:

1. Neutrophils and platelets are taken from normal (control) subjects,
2. Stimulated with plasma and serum from 21 patients in septic shock and
3. Perfused over endothelial cells.

Now, 3 groups were made with addition of each of the following, suspended in septic plasma.

• Activated protein C, or
• low-dose heparin, or
• low-dose heparin with rhAPC

What they found:

Activated protein C significantly decreased neutrophil adhesion and aggregation and increased rolling velocity in cells stimulated with both septic serum and septic plasma. Significant decreases in platelet-neutrophil aggregates induced by septic plasma were also observed.

Low-dose heparin alone had no effects on these variables.

But

The addition of low-dose heparin to cells suspended in septic plasma and rhAPC attenuated the benefits observed with rhAPC alone in each of these variables.

This is only one work but raises the question - Should we hold on using the low dose heparin as DVT prophylaxis with rhAPC {Drotrecogin alfa (activated) - Xigris} ?


* Low-dose heparin is used as unfractionated heparin in a concentration of 0.15 IU/mL. This heparin concentration, represents the concentration used for deep vein thrombosis prophylaxis, was derived as a fraction of the concentration, 0.2-0.7 IU/mL, used for full anticoagulation.


Reference: click to get abstract/article

Effect of recombinant activated protein C and low-dose heparin on neutrophil-endothelial cell interactions in septic shock - Critical Care Medicine. 34(8):2207-2212, August 2006.