may be beneficial in the chronic DIC and large vessel thrombosis associated with cancer; the APTT should be maintained at about twice normal
other indications for heparin are not supported conclusively by good trial data
natural inhibitors:
animal models of DIC suggest that supplementation with antithrombin before endotoxin challenge was beneficial but this benefit was lost if the antithrombin was given after the endotoxin
there is no good clinical data to support supplementation with natural coagulation inhibitors
other inhibitors have been proposed but there is no good evidence to support any of them:
hirudin, a leech-derived thrombin inhibitor, has little trial evidence of benefit
tranexamic acid, an inhibitor of plasmin, is best avoided as thrombosis may be increased
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