The close relationship of heparin and the vessel wall.

For over 100 years heparin has attracted interest because of its anticoagulant powers. Commercial heparin has now been shown to be a mixture of over 100 different closely related sulfated polysaccharides of which only 10% activate antithrombin-III. Fifty years ago the original research teams in Toronto and Stockholm in demonstrating the clinical uses of heparin observed that antithrombotic activity did not correspond to levels of anticoagulation. It has been shown that: (a) Heparin accumulates rapidly and specifically in the endothelium against a concentration gradient of hundreds- to thousands-fold. (b) Experimental thrombosis, however produced, is accompanied by a marked decrease in the electronegative charge of the vessel wall and the charge is restored in all cases by heparin. (c) The normal electronegative charge is due to glycosaminoglycans. Heparin possesses the strongest electronegative charge of these substances and is present in the vessel wall as a component of a larger heparitin (sulfate) proteoglycan molecule. (d) Maintenance of the normal electronegative charge depends on adequate supply of oxygen (adequate blood flow). (e) Commercial heparin releases enzymes from the endothelium, lipoprotein lipase and histaminase (D.A.O.). Lipoprotein lipase changes the composition of plasma lipids and lipoproteins and histaminase provides a check for fat absorption. The release of these enzymes decrease and prevent atherosclerotic changes. (f) After administration of commercial heparin, heparin isolated from the plasma has higher antithrombin activity than that injected. The heparin taken up by the endothelium is returned with greater activity. The anticoagulant effect of administered heparin does not produce hemorrhage since this requires simultaneous occurrence of defects in the vascular factor of hemostasis (the result of stress or pituitary-adrenal imbalance) or platelet defect. Thus, clinical effectiveness of heparin is an expression of its close relationship to the vessel wall.