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First experience in application of heparin-induced extracorporeal LDL precipitation (H.E.L.P.) in acute thromboembolic stroke

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Abstract

Heparin-induced Extracorporeal LDL <total cholesterol, triglycerides, fibrinogen >Precipitation (H.E.L.P.) was applied in cases of acute thromboembolic stroke within 48 to 96 hours after onset. 42 patients had been randomized for the trial. In Group A 12 patients underwent a single H.E.L.P. application, while remaining 10 patients formed a control group. In group B 10 patients had 10 H.E.L.P. applications, the other 10 patients firmed as controls. Results of group A: 4 days after H.E.L.P. an improvement in the Mathew Scale and in the Mini Mental State Examination could be obtained (p<0.05 each). 10 days after H.E.L.P. all the tests showed significant changes (p<0.05 in the Mathew Scale and in the Mini Mental State Examination and p<0.01 in the Activities-of-Daily-Living Score). Relatet to the controls there appeared a statistically significant difference 4 days after H.E.L.P. in the Mini Mental State Examination and in the Activities-of-Daily-Living Score (p<0.05 each). At day 10 all the tests showed a difference to the controls (p<0.05 in the Mathew Scale and p<0.01 in the other tests). Results of group B 10: One day after 1st H.E.L.P. a statistically significant difference could be observed in all the tests (p<0.05 in the Mathew Scale and the Mini Mental State Examination and p<0.01 in the Activities-of-Daily-Living Score). At that time even a difference to the controls became visible (p<0.05 in the Mathew scale, p<0.01 in the other tests). Up to 5 H.E.L.P. applications and in relation to the initial values a further improvement could be seen in the Mathew Scale (p<0.05) as well as in the Mini Mental State Examination and in the Activities-of-Daily-Living Score (p<0.01 each). However, no further improvement was observed between the 5th and the 10th H.E.L.P., but the difference to the controls remained stable in the Mathew Scale and Mini Mental State Examination (p<0.05 each) and in the Activities-of-Daily-Living Score (p<0.01).

Sommario

Prime esperienze nell'applicazione della precipitazione LDL extracorporea indotta da eparina (H.E.L.P.) nella fase acuta nell'ictus tromboembolico.

La precipitazione extracorporea LDL (colesterolo totale, trigliceridi, fibrinogeno) indotta da eparina (H.E.L.P.) è stata utilizzata nella fase acuta dell'ictus tromboembolico, tra 48 e 96 ore dall'esordio. Quarantadue pazienti sono stati scelti per randomizzazione.

Nel gruppo A, 12 pazienti sono stati sottoposti ad un'unica applicazione di H.E.L.P., mentre i restann dieci hanno costituito il gruppo di controllo. Nel gruppo B, 10 pazienti sono stati sottoposti a 10 applicazioni di H.E.L.P., mentre altri 10 hanno accettato di costituire il gruppo di controllo.

Risultati del gruppo A: quattro giorni dopo l'applicazione H.E.L.P. si è verificato un miglioramento nella scala di Mathew e nel Mini Mental State (p<0.005 in entrambi).

Dieci giorni dopo l'H.E.L.P. tutti i tests hanno dimostrato un miglioramento significativo (p<0.05 nella scala di Mathew e nel Mini Mental State; p<0.01 nel Activities-of-Daily-Living Score. Rispetto al gruppo di controllo si è dimostrata una differenza statisticamente significativa quattro giorni dopo l'H.E.L.P. al Mini Mental State e all'Activities-of-Daily-Living Score (p<0.05 in entrambi). Al giorno dieci, tutti i tests hanno dimostrato una differenza rispetto ai controlli (p<0.05 alla scala di Mathew e p<0.01 negli altri tests).

Risultati del gruppo B: un giorno dopo l'applicazione della prima H.E.L.P. è stata osservata una differenza statisticamente significativa in tutti i tests (p<0.05 alla scala di Mathew e al Mini Mental State; p<0.01 all'Activities-of-Daily-Living Score).

Contemporaneamente, si è resa evidente una differenza statisticamente significativa rispetto ai controlli (p<0.05 alla scala di Mathew, p<0.01 agli altri tests).

Fino alla 5 applicazione H.E.L.P., rispetto ai valori di base è stato dimostrato un miglioramento alla scala di Mathew (p<0.05), al Mini Mental State (p<0.01) e all'Activities-of-Daily-Living (p<0.01).

Tuttavia, non si sono osservati ulteriori miglioramenti tra la 5a e la 10a applicazione H.E.L.P.; la differenza rispetto ai controlli si è mantenuta invariata alla scala di Mathew e al Mini Mental State (p<0.05) e all'Activities-of-Daily-Living (p<0.01).

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  1. Department of Neurology, Karl-Franzens University of Graz, Auengruggerplatz 22, A-8036, Graz, Austria

    Lechner H., Walzl M., Walzl B. & Kleinert G.

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  1. Lechner H.
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  2. Walzl M.
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  3. Walzl B.
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  4. Kleinert G.
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Lechner, H., Walzl, M., Walzl, B. et al. First experience in application of heparin-induced extracorporeal LDL precipitation (H.E.L.P.) in acute thromboembolic stroke. Ital J Neuro Sci 14, 251–255 (1993). https://doi.org/10.1007/BF02335667

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