Evaluating the efficacy and safety of unfractionated heparin in patients diagnosed with sepsis

Abstract

Statement of the Problem: Unfractionated heparin (UFH) is an anticoagulant with anti-inflammatory properties. The efficacy and safety of UFH in severe sepsis or septic shock has yet to be evaluated in clinical trials. Methods of Investigation: We performed a systematic review to evaluate the current evidence regarding the use of heparin in patients with sepsis. We then conducted a cross-sectional survey to evaluate the perceived utility and current use of anticoagulants in sepsis, to assess the degree of certainty regarding clinical benefits and harms of heparin, and to assess the willingness of physicians to consider future clinical trials of heparin. Results: The pooled OR for mortality in 7 trials comparing heparin to any other intervention was 0.88 (95%CI 0.74 to 1.05, I2 0%, n=2473). A large observational cohort study also showed a similar reduction in death associated with heparin (HR 0.85, 95%CI 0.73 to 1.00, n=1390). Data from the national survey indicate that 89% (n=279) of critical care physicians believe that anticoagulant therapies used to modulate host inflammation in patients with severe sepsis or septic shock are clinically important, but not routinely used. Respondents were uncertain if UFH or LWMH are beneficial (67%, n=211), or harmful (61%, n=189) when used in this context, and 90%I(n=281) believe that further clinical trials or UFH or LMWH are warranted. Conclusion: Limited evidence to date suggests UFH may be beneficial when administered to patients with severe sepsis or septic shock. Future clinical trials are warranted and supported by a medical community that believes this avenue of research is clinically important and who is genuinely uncertain regarding the potential therapeutic benefits or harms of heparin in this patient population.