CARDIOPROTECTIVE EFFECTS OF HEPARIN OR N-ACETYLHEPARIN IN AN IN-VIVO MODEL OF MYOCARDIAL ISCHEMIC AND REPERFUSION INJURY

Objective: The aim was to determine if either heparin or N-acetylheparin could reduce the extent of myocardial injury resulting from 90 min of coronary artery occlusion and 6 h of reperfusion in the anaesthetised dog. Methods: Heparin or N-acetylheparin was given in three repeated intravenous doses of 2 mg . kg(-1). Drug or vehicle (0.9% saline) was given 75 min after onset of ischaemia and 90 and 180 min after reperfusion. To ensure an equal degree of myocardial ischaemia induced by left circumflex coronary artery occlusion among the three groups of animals studied, only animals with ischaemic zone blood flow of less than or equal to 0.16 ml . min(-1). g(-1) were included in the final analysis. Results: Ischaemic zone blood flow was 0.068 (SEM 0.016) ml . min(-1). g(-1) in control animals (n=13), 0.083 (0.017) ml . min(-1). g(-1) in heparin treated animals (n=10), and 0.094 (0.010) ml . min(-1). g(-1) in N-acetylheparin treated animals (n=10). Baseline haemodynamic variables did not differ among the three groups studied. Heparin treatment alone significantly increased bleeding time and activated partial thromboplastin time. Electrocardiographic ST segment elevation, an indicator of regional ischaemia at the onset of coronary occlusion, was not different among control, heparin, or N-acetylheparin groups. The area of the left ventricle at risk of infarct was 39.8 (1.5)%, 38.6 (0.7)%, and 37.3 (2.0)% in control, heparin, and N-acetylheparin treated groups, respectively. Myocardial infarct size, as a percentage of area at risk, was 43.0 (3.7)%, 30.7 (3.9)%, and 24.5 (3.7)% in control, heparin, and N-acetylheparin treated animals, respectively (P < 0.05, control v heparin and N-acetylheparin). Conclusions: The glycosaminoglycans, heparin or N-acetylheparin, can reduce the extent of myocardial injury associated with regional ischaemia and reperfusion in the canine heart. The mechanism of cytoprotection is unrelated to alterations in the coagulation cascade and may involve inhibition of complement activation in response to tissue injury.