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No effect of unfractioned or low molecular weight heparin treatment on markers of vascular wall and hemostatic function in incipient diabetic nephropathy

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Author: Myrup, B. · Jensen, T. · Gram, J. · Kluft, C. · Jespersen, J. · Deckert, T.
Institution: Gaubius Instituut TNO
Source:Diabetes Care, 10, 20, 1615-1619
Identifier: 234062
Keywords: Biology · Biological marker · High density lipoprotein cholesterol · Insulin · Low molecular weight heparin · Placebo · Plasminogen activator inhibitor 1 · Prothrombin · Sodium chloride · Thrombin · Tinzaparin · Blood clotting · Blood vessel wall · Cardiovascular disease · Clinical article · Clinical trial · Controlled clinical trial · Controlled study · Diabetic nephropathy · Double blind procedure · Drug effect · Hemostasis · Insulin dependent diabetes mellitus · Intravenous drug administration · Randomized controlled trial · Subcutaneous drug administration · Adult · Albuminuria · Antithrombin III · Capillaries · Cardiovascular Diseases · Cholesterol · Cholesterol, HDL · Diabetes Mellitus, Type 1 · Diabetic Angiopathies · Diabetic Nephropathies · Double-Blind Method · Female · Fibrinogen · Hemostasis · Heparin · Heparin, Low-Molecular-Weight · Humans · Male · Middle Aged · Muscle, Smooth, Vascular · Peptide Fragments · Peptide Hydrolases · Placebos · Plasminogen Activator Inhibitor 1 · Protein Precursors · Prothrombin · Tissue Plasminogen Activator · Triglycerides · von Willebrand Factor


OBJECTIVE - The high risk for cardiovascular disease in IDDM patients with nephropathy may be mediated by abnormal function of the vascular wall. We investigated whether heparin was able to modulate markers of vascular wall and hemostatic function in patients with incipient nephropathy. RESEARCH DESIGN AND METHODS - Thirty-five IDDM patients with incipient nephropathy were randomized to treatment with placebo, unfractioned heparin, or low molecular weight heparin in a double-blind trial. The treatment was given as 1 h of conventional intravenous high-dose treatment and in a conventional subcutaneous low-dose regime for 3 months. Transcapillary escape rate of albumin and plasma levels of von Willebrand factor, fibrinogen, prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, tissue type plasminogen activator, tissue plasminogen activator inhibitor type 1, total cholesterol, HDL cholesterol, and triglycerides were measured before and after treatment. Of the patients, 31 completed the study. RESULTS - We found no significant effect of heparin on markers of vascular wall and hemostatic function by any of the treatments. CONCLUSIONS - Treatment with high- or low-dose heparin induced no modulation of markers of vascular wall or hemostatic function in IDDM patients with incipient diabetic nephropathy.