title: Abolition of anti-adhesiogenic effect of heparin by protamine sulfate.
abstract: OBJECTIVE
  Intraabdominal adhesion is a frequently encountered condition after surgery and can end up in important complications. The objective of this study is to test whether the antiadhesiogenic effect of heparin could be antagonized by administration of protamine in a rat model.
  
  
  METHODS
  A laparotomy with caecal abrasion model was used in 40 Wistar rats. Single dose of 1 cc saline was injected subcutaneously (SC) in one group (control); 50 IU/kg heparin was injected SC in Group 2; 50 IU/kg protamine SC given to Group 3; 50 IU/kg heparin and 50 IU/kg protamine was given SC to Group 4 for 3 consecutive days. Each group consisted of 10 rats. All rats were sacrificed one week later for macroscopic and microscopic examination and they were scored for adhesion using Mazuji adhesion scale.
  
  
  RESULTS
  There was significant difference in the heparin group with respect to Mazuji adhesion score, histopathological score (fibrosis, inflammation and vascular proliferation) and S-100 staining (P < 0.05). Additionally, the inflammation was more severe in the mucosa and submucosa compared to serosa in the heparin group (P < 0.01). With respect to fibrosis and vascular proliferation, apart from submucosal fibrosis, heparin group was statistically superior to the control group by means of each layer (P < 0.01).
  
  
  CONCLUSIONS
  It seems that heparin is effective preventing adhesion in this rat model. Abolition of heparin's antiadhesiogenic effect by protamine administration is likely exerted via its antithrombine activity. Clinical application of our findings in intraabdominal surgery warrants further investigation.
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey. Electronic address: enreyhan@yahoo.com.
authors.forename: Enver
authors.initials: E
authors.lastname: Reyhan
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: İrkörücü
authors.affiliation: Department of Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Sürmelioğlu
authors.affiliation: Department of Pathology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Selvinaz
authors.initials: S
authors.lastname: Özkara
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Kamuran Cumhur
authors.initials: KC
authors.lastname: Değer
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aziret
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Erdem
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Çetinkünar
authors.affiliation: Department of Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Tilki
authors.affiliation: Department of Pathology, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Pelin
authors.initials: P
authors.lastname: Demirtürk
authors.affiliation: Department of Surgery, Adana Numune Training and Research Hospital, Adana, Turkey.
authors.forename: Edip
authors.initials: E
authors.lastname: Akpinar
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005355:Fibrosis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage*; D007249:Inflammation / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D007813:Laparotomy / Q000009:adverse effects*; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D011479:Protamines / Q000008:administration & dosage / Q000009:adverse effects*; D051381:Rats; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D011479:Protamines; D006493:Heparin
keywords: Adhesion; Anticoagulant; Antidote; Antithrombine; Protamine sulfate