Theuse of heparin remains controversial; studies have shown it to stimulate the releaseof lipoprotein lipase from endothelial cells, allowing it to degrade chylomicronsthus decreasing TG levels.13 Plasmapheresis can be used for removal of plasma lipoproteins, reducing TGlevels rapidly in case of organ dysfunction or failure.14 A few case reports in the literature have demonstrated that apheresis forHTG-induced AP must be initiated early for benefit. This evidence concerns the gene LPL and alkaline phosphatase measurement.