Efficacy and safety of heparin in patients with sepsis: a systematic review and meta-analysis

Zarychanski, Ryan; Abou-Setta, AM; Kanji, Salmaan; Turgeon, AF; Kumar, Anand; Ds, Houston; Rimmer, Emily; Houston, BL; McIntyre, Lauralyn; Fox-Robichaud, A.; Pc, Hébert; Dj, Cook; Fergusson, DA

doi:10.1186/cc14203

Cited by 60 publications

(81 citation statements)

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“…61 However, a clinically relevant effect of heparin in patients with DIC has never been unequivocally demonstrated in controlled clinical trials, although indirect evidence is accumulating that heparin might be of benefit. 62,63 In addition, there are several studies showing that all critically ill patients need adequate prophylaxis for venous thromboembolism, usually with (low molecular weight) heparin. 64 Therapeutic doses of heparin are indicated in patients with clinically overt thromboembolism and may be considered in case of extensive thrombotic manifestations such as in purpura fulminans or acral ischemia.…”

Section: Comments About Patientmentioning

confidence: 99%

How I treat disseminated intravascular coagulation

Levi

Scully

2018

Blood

211

191

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Disseminated intravascular coagulation (DIC) is a condition characterised by systemic activation of coagulation, potentially leading to thrombotic obstruction of small and midsize vessels, thereby contributing to organ dysfunction. At the same time, ongoing consumption of platelets and coagulation proteins results in thrombocytopenia and low concentrations of clotting factors, which may cause profuse hemorrhagic complications. DIC is always secondary to an underlying condition, such as severe infections, solid or hematologic malignancies, trauma, or obstetric calamities. A reliable diagnosis of DIC can be made through simple scoring algorithms based on readily available routine hemostatic parameters. The cornerstone of supportive treatment of this coagulopathy is management of the underlying condition.

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Section: Comments About Patientmentioning

confidence: 99%

How I treat disseminated intravascular coagulation

Levi

Scully

2018

Blood

211

191

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“…The guideline panel has elected to make no recommendation pending these new results. Two systematic reviews showed a potential survival benefit of heparin in patients with sepsis without an increase in major bleeding [344]. However, overall impact remains uncertain, and heparin cannot be recommended until further RCTs are performed.…”

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confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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“…5 While agents such as antithrombin III and activated protein C (APC) initially held promise in treating sepsis, their clinical utility has been limited by a lack of efficacy and bleeding risks, 6,7 and the benefit of more standard anticoagulants such as heparin is uncertain. 8,9 Better understanding of the elements of inflammatory thrombosis and identification of targets for safe intervention represent a significant medical priority.…”

Section: Introductionmentioning

confidence: 99%