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The value of additional heparin therapy in patients with malaria tropica and signs of intravascular coagulation is far from clear. Whereas at one side heparin could perhaps be of value to prevent further obstruction of the microcirculation; at the other hand heparin could add additional bleeding risk when restoration of a hemostatic defect does not occur (e.g. when there is concomittant liver damage or uremic thrombopathy). Nine non immune patients with imported malaria tropica were followed during varying period for blood platelets number, coagulation factors, circulating fibrin monomers and fibrinogen degradation products (F.D. P./f. d. p. ). Three of them had severe renal damage and two signs of cerebral malaria. All patients showed initially before the 15th day of illness an episode of thrombocytopenia. None of them had signs of circulating fibrin monomers. Elevated levels of F. D. P. /f. d.p. were only occasionally found and were not seen in the patients with cerebral malaria and/or severe renal damage. Low fibrinogen levels were found in only three patients (all had renal damage). There were no signs of diffuse intravascular coagulation in those patients, some of the patients showed coagulation defects attributed to liver damage. Therefore intravenous heparin was not additionaly given. All patients recovered completely.

Diffuse or Localized Intravascular Coagulation in Severe Cases of Malaria Tropica: Heparin or Not?