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Molecules 2017, 22(5), 724;

Heparin and Heparin-Derivatives in Post-Subarachnoid Hemorrhage Brain Injury: A Multimodal Therapy for a Multimodal Disease

Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Department of Neurosurgery, University of Louisville, Louisville, KY 40208, USA
Author to whom correspondence should be addressed.
Academic Editors: Giangiacomo Torri and Jawed Fareed
Received: 29 March 2017 / Revised: 24 April 2017 / Accepted: 26 April 2017 / Published: 2 May 2017
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Pharmacologic efforts to improve outcomes following aneurysmal subarachnoid hemorrhage (aSAH) remain disappointing, likely owing to the complex nature of post-hemorrhage brain injury. Previous work suggests that heparin, due to the multimodal nature of its actions, reduces the incidence of clinical vasospasm and delayed cerebral ischemia that accompany the disease. This narrative review examines how heparin may mitigate the non-vasospastic pathological aspects of aSAH, particularly those related to neuroinflammation. Following a brief review of early brain injury in aSAH and heparin’s general pharmacology, we discuss potential mechanistic roles of heparin therapy in treating post-aSAH inflammatory injury. These roles include reducing ischemia-reperfusion injury, preventing leukocyte extravasation, modulating phagocyte activation, countering oxidative stress, and correcting blood-brain barrier dysfunction. Following a discussion of evidence to support these mechanistic roles, we provide a brief discussion of potential complications of heparin usage in aSAH. Our review suggests that heparin’s use in aSAH is not only safe, but effectively addresses a number of pathologies initiated by aSAH. View Full-Text
Keywords: heparin; enoxaparin; subarachnoid hemorrhage; edema; brain injury; inflammation heparin; enoxaparin; subarachnoid hemorrhage; edema; brain injury; inflammation

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Hayman, E.G.; Patel, A.P.; James, R.F.; Simard, J.M. Heparin and Heparin-Derivatives in Post-Subarachnoid Hemorrhage Brain Injury: A Multimodal Therapy for a Multimodal Disease. Molecules 2017, 22, 724.

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