Emerging role of anticoagulants and fibrinolytics in the treatment of acute respiratory distress syndrome.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with high mortality rates despite therapeutic advances. The pathogenesis of ALI and ARDS is similar to that of sepsis, as these disease states involve uncontrolled host defense responses that lead to inflammation, endothelial damage, enhanced coagulation, diminished fibrinolysis, and fibroproliferation. Recent studies of anticoagulants have shown positive outcomes in patients with severe sepsis. In addition, emerging evidence suggests that the use of anticoagulants, such as tissue factor pathway inhibitor, antithrombin, thrombomodulin, heparin, activated protein C, and fibrinolytics (plasminogen activators and particularly tissue plasminogen activator), may be useful in the treatment of ALI and ARDS. Data from experimental models of sepsis, ALI, and ARDS indicate that some of these agents improve lung function and oxygenation. Although clinical data are less convincing than these findings, results from clinical trials may influence the design of future studies.
MacLaren
Robert
R
Departments of Clinical Pharmacy, School of Pharmacy, University of Colorado at Denver and Health Sciences Center, Denver, Colorado 80260, USA.
Stringer
Kathleen A
KA
D000208:Acute Disease; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D018805:Sepsis / Q000188:drug therapy / Q000503:physiopathology
D000925:Anticoagulants; D005343:Fibrinolytic Agents