HEPARIN-INDUCED EXTRACORPOREAL LOW-DENSITY-LIPOPROTEIN PRECIPITATION AND LOW-DENSITY-LIPOPROTEIN CHEMOADSORPTION ONTO DEXTRAN SULFATE - A COMPARISON

Both heparin-induced extracorporeal low-density lipoprotein precipitat ion (HELP) and dextran sulfate (DS) apheresis are potent tools for acu te and long-term risk factor reduction in the secondary prevention tre atment of coronary patients suffering from recalcitrant hypercholester olemia. They combine high efficacy and selectivity of risk factor remo val. Whereas LDL cholesterol and lipoprotein (a) adsorption onto DS of fers the advantage of an unlimited treatable plasma volume and somewha t easier handling, HELP reduces fibrinogen more effectively and does n ot interfere with angiotension-converting enzyme (ACE) inhibitors. Bot h systems can improve blood rheology and induce regression or stabiliz e coronary lesions. In an uncontrolled trial, HELP reduced the inciden ce of myocardial infarction. To date, no controlled prospective trials have been performed comparing the two systems with respect to their l ong-term risk factor reduction and their effect on coronary lesions, m orbidity, and mortality.