Although insulin has been considered to be the common approach for early triglyceride-lowering therapy in HTG-AP, the unresolved question has been whether the addition of heparin is superior over insulin alone.29,30 A previous study19 proposed that LMWH may ameliorate AP through enhanced catabolism of triglyceride-rich lipoproteins. This evidence concerns the gene INS and alkaline phosphatase measurement.