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    Comparing the potential effects of standardized heparin sodium and tinzaparin sodium on microvascular thrombosis in the late phase of intraabdominal sepsis
    (Surgical Society of Northern Greece, 2019) Özozan, Ömer Vefik; Karakahya Murat; Külah Bahadır; Coşkun Faruk
    Aim of the Study: The aim of this study is to compare the potential effects of standardized heparin sodium and tinzaparin sodium, which is a member of low molecular weight heparin (LMWH), on microvascular thrombosis in the late phase of intraabdominal polimicrobial sepsis on an experimental model of caecal ligation and puncture. Material and Methods: Thirty Wistar albino rats with an average weight of 250-300 gr were divided into 5 groups in a randomized fashion: Control (C) group (6 rats), caecal ligation and puncture (CLP) group (6 rats), conventional heparin (H) group (6 rats), tinzaparin sodium (T) group (6 rats), combined heparin and tinzaparin sodium (H+T) group (6 rats). Only laparotomy was done to rats in the control group. CLP of Wichterman’s was done to all other groups. After 2 hours 200 IU/kg of heparin sodium to all rats in the H group, 200 IU/kg of tinzaparin sodium to all rats in the T group, 100IU/kg heparin sodium and 100 IU/kg tinzaparin sodium to all rats in the H+T group were injected subcutaneously. All rats were sacrified 24 hours after CLP. Blood samples for leucocyte counts, thrombocyte counts, hemoglobin levels, antithrombin-III levels were obtained. Lung and intestinal tissue samples were obtained for histopathological investigation. All the tissue samples were assessed by the same pathologist who is unaware of the groups. All the data obtained were analyzed by SPSS version 13.0 Windows program, intergoup differences were analyzed by Kruskal Wallis and Mann Whitney U nonparametric tests. Results: Leucocyte levels at 24. hour in all groups were found to be statistically higher than the leucocyte levels in the C group. Thrombocyte levels at 24. hour in all groups were found to be statistically lower than the C group. Thrombocyte levels in the H group, T group and H+T group were statistically higher than the thrombocyte levels in CLP group. Antithrombin-III levels at 24. hour in all groups were found to be statistically lower than the antithrombin-III levels in the C group. Antithrombin-III levels in the T group were statistically higher than the antithrombin-III levels in the H group. In all treatment groups microvascular thrombosis in lung and intestinal tissue samples were lower than the C group whereas the effects of heparin sodium and tinzaparin on inhibiton of microvascular thrombosis were found to be similar. There was no difference between treatment groups and control group when inhibition of late phase inflammation is regarded. Conclusion: While inhibiting microvascular thrombosis, anticoagulant therapy does not prevent sepsis induced inflammation. Anticoagulant treatments may be adjunctive rather than a definitive treatment in sepsis. Tinzaparin sodium may be a more appropriate choice in microvascular thrombosis treatment in sepsis since it offers a lower hemorrhage risk than unfractioned heparin with a similar antithrombotic potential. © 2019 Surgical Society of Northern Greece. All rights reserved.