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Review
. 2017 Nov;5(22):444.
doi: 10.21037/atm.2017.08.23.

Nebulized anticoagulants in lung injury in critically ill patients-an updated systematic review of preclinical and clinical studies

Jenny Juschten  1   2   3 , Pieter R Tuinman  2 , Nicole P Juffermans  1   3 , Barry Dixon  4 , Marcel Levi  5 , Marcus J Schultz  1   3   6
Affiliations
Review

Nebulized anticoagulants in lung injury in critically ill patients-an updated systematic review of preclinical and clinical studies

Jenny Juschten et al. Ann Transl Med. 2017 Nov.

Abstract

Pneumonia, inhalation trauma and acute respiratory distress syndrome (ARDS), typical causes of lung injury in critically ill patients, are all three characterized by dysregulated inflammation and coagulation in the lungs. Nebulized anticoagulants are thought to have beneficial effects as they could attenuate pulmonary coagulopathy and maybe even affect pulmonary inflammation. A systematic search of the medical literature was performed using terms referring to aspects of the condition ('pneumonia', 'inhalation trauma' and 'ARDS'), the intervention ('nebulized', 'vaporized', and 'aerosolized') and anticoagulants limited to agents that are commercially available and frequently given or tested in critically ill patients ['heparin', 'danaparoid', 'activated protein C' (APC), 'antithrombin' (AT) and 'tissue factor pathway inhibitor' (TFPI)]. The systematic search identified 16 articles reporting on preclinical studies and 11 articles reporting on human trials. All nebulized anticoagulants attenuate pulmonary coagulopathy in preclinical studies using various models for lung injury, but the effects on inflammation are less consistent. Nebulized heparin, danaparoid and TFPI, but not APC and AT also reduced systemic coagulation. Nebulized heparin in lung injury patients shows contradictory results, and there is concern over systemic side effects of this strategy. Future studies need to focus on the way to nebulize anticoagulants, as well as on efficient but safe dosages, and other side effects.

Keywords: Nebulization; anticoagulants; lung injury.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Prisma flow diagram showing the results of literature search and selection strategy.
See this image and copyright information in PMC

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