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. 2012 Aug 15:12:43.
doi: 10.1186/1471-2466-12-43.

Early intravenous unfractionated heparin and outcome in acute lung injury and acute respiratory distress syndrome: a retrospective propensity matched cohort study

Jorrit J Hofstra  1 , Alexander P J Vlaar, David J Prins, Gavin Koh, Marcel Levi, Marcus J Schultz, Jan M Binnekade, Nicole P Juffermans
Affiliations

Early intravenous unfractionated heparin and outcome in acute lung injury and acute respiratory distress syndrome: a retrospective propensity matched cohort study

Jorrit J Hofstra et al. BMC Pulm Med. .

Abstract

Background: Acute lung injury (ALI) is characterized by a pro-coagulant state. Heparin is an anticoagulant with anti-inflammatory properties. Unfractionated heparin has been found to be protective in experimental models of ALI. We hypothesized that an intravenous therapeutic dose of unfractionated heparin would favorably influence outcome of critically ill patients diagnosed with ALI.

Methods: Patients admitted to the Intensive Care Unit (ICU) of a tertiary referral center in the Netherlands between November 2004 and October 2007 were screened. Patients who developed ALI (consensus definition) were included. In this cohort, the impact of heparin use on mortality was assessed by logistic regression analysis in a propensity matched case-control design.

Results: Of 5,561 admitted patients, 2,138 patients had a length of stay > 48 hours, of whom 723 were diagnosed with ALI (34%), of whom 164 received intravenous heparin. In a propensity score adjusted logistic regression analysis, heparin use did not influence 28-day mortality (odds ratio 1.23 [confidence interval 95% 0.80-1.89], nor did it affect ICU length of stay.

Conclusions: Administration of therapeutic doses of intravenous unfractionated heparin was not associated with reduced mortality in critically ill patients diagnosed with ALI. Heparin treatment did not increase transfusion requirements. These results may help in the design of prospective trials evaluating the use of heparin as adjunctive treatment for ALI.

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Figures

Figure 1
Figure 1
Flowchart of patients diagnosed with acute lung injury. Abbreviations; ALI = acute lung injury, ARDS = acute respiratory distress syndrome.
Figure 2
Figure 2
Cumulative survival of patients receiving heparin vs. patients who had not received heparin based on a Cox proportional hazard model adjusted for propensity.
See this image and copyright information in PMC

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