MEDIUM MOLECULAR WEIGHT HEPARIN FOR TREATMENT AND SECONDARY PREVENTION OF ISCHEMIC STROKE

摘要

It is the thorough consistency between the pathophysiological pattern of ischemic stroke and the haemostaseological characteristics of LD Heparin 10,5 Kd that confer specificity to the pertinent patent claim.In particular it is specific role of Tissue factor (TF) and its complex with Factor Vila respectively trigging off cerebral thrombogenesis that condition the rationale of LD Heparin in ischemic stroke. It is the TF/F Vila - complex that makes up the adequate substrate for LD Heparin which is rather resistant to the classical antithrombin-mediated influence but primarily responsive to Tissue Factor Pathway Inhibitor (TFPI). Its extraordinary release on LD Heparin in which LMWH (Enoxaparin) is exceeded threefold constitutes the rationale of striking out on the new indication of stroke.The TFPI-dependent impact is safeguarded by the controlled curtailment of anti-factor Xa activity as permissive for the inhibition of TF/F VIIa, the ratios of activities between TFPI and anti-factor Xa as expressed in the AUC's of both heparins differing threefold either.;It is not only that disease-centered antithrombotic effect but also the way how the risk of bleeding is tackled in general in which LD Heparin contrasts with all others in its class: Owing to the "double truncation" of the molecular spectrum i.e. through the curtailment of its low and very long molecular species major sources of bleeding are excluded.The inventory of auxiliary properties in particular the adequate pharmacokinetics, the trimmed peak blood levels, the lack of plasmatic accumulation in age-dependent decline of renal function and renal insufficiency, the availability of valid and sensitive monitoring (APTT), and last but not least the prompt and complete reversibility of the anticoagulatory effect as contrasted to LMWH substantiates the indication-specific profile.On the whole the multipronged refinements of LD Heparin are aiming at a heightened benefit-risk-ratio ("therapeutic window") which takes specific shape in cerebral thrombosis.The patent claim associated reads: LD Heparin 10,5 Kd (10-11Kd) for the treatment and secondary prevention of ischemic stroke.