Nebulized heparin reduces levels of pulmonary coagulation activation in acute lung injury

nebulized heparin in patients with acute lung injury [1]. Patients were administered heparin at doses of 50,000, 100,000, 200,000, or 400,000 U/day for 2 days, and broncho alveolar lavage (BAL) fl uid samples were taken at baseline and after the last heparin dose. Th e study demonstrated a trend to reduced coagulation activation (prothrombin fragments) in BAL fl uid after the last dose of nebulized heparin [1]. Following publication of these data, we were off ered the possibility of further analysis of the BAL fl uid with additional markers of coagulation activation, including thrombin-antithrombin complexes (TATcs), fi brin degrada tion products (FDPs), and plasminogen activator activity (PAI-1) levels. We wish to publish the results of this further analysis. Th e 400,000 U/day group had one patient more than the same group in the previously published data. We found that TATc and FDP levels were signifi cantly reduced in patients treated with 400,000 U/day of nebulized heparin, but not PAI-1 (Figure 1 overleaf ). We believe that these data are important as they demonstrate for the fi rst time that nebulized heparin signifi cantly reduces coagulation activation in the lungs of critically ill patients with acute lung injury. Th is may be important knowledge as infl ammatory mechanisms related to coagulation activation, such as hyaline membrane formation and microvascular thrombosis, may mediate lung injury [2,3].