Zhiyong Liu1, Hong Zhu, Xiaochun Ma. 1. Department of Critical Care Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China. Corresponding author: Ma Xiaochun, Email: xcma2972@sina.com.
Abstract
OBJECTIVE: To systemically review the efficacy and safety of heparin for treatment of sepsis. METHODS: Database search of IM/MEDLINE, Cochrane Library, SCIE, CBM, CNKI, VIP Data, WanFang Data (from January 2000 to June 2012) was conducted. The quality of included randomized controlled trials (RCTs) about heparin for treatment of sepsis was assessed, and relevant data were extracted according to the inclusion and exclusion criteria. Then meta analysis was performed using RevMan 5.1. RESULTS: 17 trials with 1 167 participants were included. The results of meta-analysis showed: compared with the control group, heparin significantly decreased 28-day mortality in patients with sepsis [odds ratio (OR)=0.59, 95% confidence interval (95%CI) 0.45-0.77, P=0.0001]; heparin did not deteriorate coagulation disorders, but corrected sepsis-induced platelet (PLT) count reduction [mean difference (MD)=13.94, 95%CI 10.15 to 17.72, P<0.000 01], while it had no significant effect on the activated partial thromboplastin time (APTT) and prothrombin time (PT, APTT: MD=-3.18, 95%CI -6.88 to 0.53, P=0.09; PT: MD=-0.68, 95%CI -1.48 to 0.12, P=0.09). There was no significant difference between the two groups in the incidence of bleeding either. Acute physiology and chronic health evaluation II (APACHEII) score of heparin group was significantly lower than that of the control group (MD=-2.58, 95%CI -3.29 to -1.87, P<0.000 01), and the incidence of multiple organ dysfunction syndrome (MODS) was significantly lower than that of the control group (OR=0.32, 95%CI 0.17 to 0.61, P=0.000 6). In addition, heparin could shorten intensive care unit (ICU) stay (MD=-4.43, 95%CI -6.79 to -2.07, P=0.000 2), whereas it showed no significant effect on the total length of hospital stay. CONCLUSIONS: Heparin can ameliorate sepsis, and has high degree of safety and lower hospital expense. Due to limitation of the quality of included studies, larger sample and well-designed RCTs are needed to further support this conclusion.
OBJECTIVE: To systemically review the efficacy and safety of heparin for treatment of sepsis. METHODS: Database search of IM/MEDLINE, Cochrane Library, SCIE, CBM, CNKI, VIP Data, WanFang Data (from January 2000 to June 2012) was conducted. The quality of included randomized controlled trials (RCTs) about heparin for treatment of sepsis was assessed, and relevant data were extracted according to the inclusion and exclusion criteria. Then meta analysis was performed using RevMan 5.1. RESULTS: 17 trials with 1 167 participants were included. The results of meta-analysis showed: compared with the control group, heparin significantly decreased 28-day mortality in patients with sepsis [odds ratio (OR)=0.59, 95% confidence interval (95%CI) 0.45-0.77, P=0.0001]; heparin did not deteriorate coagulation disorders, but corrected sepsis-induced platelet (PLT) count reduction [mean difference (MD)=13.94, 95%CI 10.15 to 17.72, P<0.000 01], while it had no significant effect on the activated partial thromboplastin time (APTT) and prothrombin time (PT, APTT: MD=-3.18, 95%CI -6.88 to 0.53, P=0.09; PT: MD=-0.68, 95%CI -1.48 to 0.12, P=0.09). There was no significant difference between the two groups in the incidence of bleeding either. Acute physiology and chronic health evaluation II (APACHEII) score of heparin group was significantly lower than that of the control group (MD=-2.58, 95%CI -3.29 to -1.87, P<0.000 01), and the incidence of multiple organ dysfunction syndrome (MODS) was significantly lower than that of the control group (OR=0.32, 95%CI 0.17 to 0.61, P=0.000 6). In addition, heparin could shorten intensive care unit (ICU) stay (MD=-4.43, 95%CI -6.79 to -2.07, P=0.000 2), whereas it showed no significant effect on the total length of hospital stay. CONCLUSIONS:Heparin can ameliorate sepsis, and has high degree of safety and lower hospital expense. Due to limitation of the quality of included studies, larger sample and well-designed RCTs are needed to further support this conclusion.