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Front. Neurol. | doi: 10.3389/fneur.2018.00097

Heparin: The Silver Bullet of Aneurysmal Subarachnoid Hemorrhage?

  • 1Department of Neurological Surgery, University of Louisville, United States

Various neurological diseases have recently been associated with neuro-inflammation and worsening outcomes. Subarachnoid hemorrhage has been shown to generate a potent neuro-inflammatory response. Heparin is a potential effective anti-inflammatory agent to prevent initial injury as well as delayed neurological decline. Different mechanisms of action for heparin have been proposed including, but not limited to the binding and neutralization of oxy-hemoglobin, decreased transcription and signal transduction of endothelin-1, inhibition of binding to vessel wall selectins and vascular leakage into the subarachnoid space as well as direct binding and neutralization of inflammatory molecules. With a reasonably safe side-effect profile, heparin has shown significant promise in small series in human studies of aneurysmal subarachnoid hemorrhage in decreasing both initial and delayed neurological injury. Further studies are needed to validate the variety of neuroprotective features of heparin in subarachnoid hemorrhage as well as other disease states.

Keywords: Unfractionated heparin, Neuroprotection, Neuro-inflammation, Subarachnoid Hemorrhage, delayed neurological injury, Vasospasm, Intracranial

Received: 09 Sep 2017; Accepted: 12 Feb 2018.

Edited by:

J Marc Simard, University of Maryland, Baltimore, United States

Reviewed by:

Jeanne Teitelbaum, McGill University, Canada
Benjamin A. Emanuel, Keck School of Medicine of USC, University of Southern California, United States  

Copyright: © 2018 Khattar and James. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Robert F. James, University of Louisville, Department of Neurological Surgery, Louisville, Kentucky, United States, robert.james@louisville.edu