The Antiadhesive Effects of Bemiparin Sodium vs Hyaluronic Acid on a Rat Uterine Horn Adhesion Model: A Randomized Controlled Experimental Study

INTRODUCTION: Purpose: To determine the antiadhesive effects of bemiparine sodium compared to hyaluronic acid based jel on a standard adhesion formation model of rat uterine horn.

METHODS: Twenty non-pregnant female Sprague Dawley rats weighing 180-220 g were used to inflict a standardized model of adhesion formation on a rat uterine horn. The rats were randomized into four groups. Control group (group 1), bemiparin group (group 2), HA (hyaluronic acid) group (group 3) and bemiparin+hyaluronic acid group (group 4). Ten standardized lesions were inflicted using bipolar cauterization. The uterine horns of 20 rats were evaluated macroscopically, microscopically and with immunohistochemistry. For macroscopic evaluation; “adhesion type”, “adhesion tenacity”, “extent of adhesions” and “total macroscopic adhesion score” were determined. For microscopic evaluation; inflammation and fibrosis formation was evaluated. Immunohistochemistry scoring was performed utilizing VEGF and TGF-β1 markers.

RESULTS: Results: Macroscopic adhesion scores, including “adhesion type”, “adhesion extent” and “total macroscopic adhesion score” in the bemiparin+HA group (group4) was significantly lower than those in the control group (group1) and group HA (group3) (p<0.05). Among these three categories;bemiparin +HA (group4) had a significantly lower score than group HA (group3) in terms of adhesion type (p<0,01) and bemiparin group (group2) had a lower score than HA group (group3) in in terms of adhesion extent (p<0,05). There were no statistical differences across all four groups for microscopic inflammation, fibrosis and immunohistochemistry staining.

DISCUSSION AND CONCLUSION: The combined use of bemiparin and HA may be effective in preventing macroscopic pelvic adhesion formation. Clinical trials on humans should be conducted for further recommendations.