Heparin–Induced Extracorporeal Low–Density Lipoprotein Precipitation and Low–Density Lipoprotein Chemoadsorption onto Dextran Sulfate: A Comparison

Abstract: Both heparin–induced extracorporeal low–density lipoprotein precipitation (HELP) and dextran sulfate (DS) apheresis are potent tools for acute and long–term risk factor reduction in the secondary prevention treatment of coronary patients suffering from recalcitrant hypercholesterolemia. They combine high efficacy and selectivity of risk factor removal. Whereas LDL cholesterol and lipoprotein (a) adsorption onto DS offers the advantage of an unlimited treatable plasma volume and somewhat easier handling, HELP reduces fibrinogen more effectively and does not interfere with angiotension converting enzyme (ACE) inhibitors. Both systems can improve blood rheology and induce regression or stabilize coronary lesions. In an uncontrolled trial, HELP reduced the incidence of myocardial infarction. To date, no controlled prospective trials have been performed comparing the two systems with respect to their long–term risk factor reduction and their effect on coronary lesions, morbidity, and mortality.