Issue |
J Extra Corpor Technol
Volume 49, Number 3, September 2017
|
|
---|---|---|
Page(s) | 192 - 197 | |
DOI | https://doi.org/10.1051/ject/201749192 | |
Published online | 15 September 2017 |
Review Articles
Heparin: Effects upon the Glycocalyx and Endothelial Cells
Address correspondence to: Bruce D. Spiess, MD, FAHA, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, P.O. Box 100254, Gainesville, FL 32610. E-mail: bspiess@anest.ufl.edu
Received:
23
December
2016
Accepted:
22
March
2017
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?
Key words: CPB / anticoagulation / ischemia/reperfusion / platelets / thrombosis
© 2017 AMSECT
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