• Yutang Li, Chunwen Guo, Hui Liu, Zhihao Yuan, Hui Lin, Yan Wang, and Hong Yan.
• Department of Critical Care Medicine, 180th Hospital of Chinese PLA, Quanzhou 362000, Fujian, China. Corresponding author: Yan Hong, Email: yanhong1964@163.com.
• Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Aug 1; 27 (8): 649-52.

ObjectiveTo study the effect of low molecular weight heparin sodium ( LMWHS ) therapy for exertional heat stroke ( EHS ) patients with pre-disseminated intravascular coagulation ( pre-DIC ).MethodsA prospective randomized controlled trial ( RCT ) was conducted. Thirty-six patients with EHS with pre-DIC admitted to Department of Critical Care Medicine of 180th Hospital of Chinese PLA from April 2012 to November 2014 were divided into heparin sodium group ( n = 20 ) and LMWHS group ( n = 16 ) in accordance with the random number table. All patients received bundle treatment after being admitted to the hospital, including rapid cooling, fluid resuscitation, organ support ( mechanical ventilation, hemopurification if necessary ), supplement of pro-coagulation factors, etc. The patients in heparin sodium group were treated with continuous heparin sodium 12 500 U throughout 24 hours with intravenous pump for 5 days, and the patients in LMWHS group were given LMWHS 2 500 U subcutaneously, twice a day for 5 days.The incidence of DIC, incidence of bleeding and mortality of two groups were compared.The platelet count ( PLT ), prothrombin time ( PT ), activated partial thromboplastin time ( APTT ), fibrinogen ( Fib ) and D-dimer of each patient between pre and post treatment times were compared.ResultsNo significant difference was found in the incidence of DIC and mortality between LMWHS group and heparin sodium group ( 31.2% vs. 30.0%, χ (2) = 0.007, P = 0.936; 6.2% vs. 5.0%, χ (2) = 0.026, P = 0.871 ). Incidence of bleeding during treatment in LMWHS group was significantly lower than that in heparin sodium group ( 12.5% vs. 45.0%,χ (2) = 4.425, P = 0.035 ). After treatment, PLT in both LMWHS group and heparin sodium group was significantly increased compared with that before treatment ( ×10(9)/L: 140.5±17.5 vs. 110.5±16.5, 152.6±21.5 vs. 120.0±20.0, both P < 0.05 ) and D-dimer was significantly decreased ( mg/L: 0.5±0.1 vs. 3.2±1.2, 0.6±0.2 vs. 4.4±1.8, both P < 0.05 ). APTT after treatment in heparin sodium group was significantly prolonged compared with that before treatment ( s: 75.3±10.6 vs. 44.1±8.2, P < 0.05 ) while no change in APTT was found in LMWHS group ( s: 38.6±5.5 vs. 42.1±8.4, P > 0.05 ). No significant difference was found in PT and Fib between pre and post treatment in all the patients.ConclusionsWhen LMWHS was applied in EHS patients in pre-DIC stage, it could not only prevent DIC as efficiently as heparin sodium, but also results in lower incidence of bleeding. So LMWHS is safer.

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