Nebulized anticoagulants for acute lung injury - a systematic review of preclinical and clinical investigations

Table 2 Human models of acute lung injury evaluating the effects of treatment with nebulized anticoagulant therapy.

Drug	Model, design, dose and nebulizer	Effect parameter, observed effect and safety	Reference
Heparin	RCT of 50 patients expected to need > 48 hours of MV 25,000 U 6 dd for 14 days Aeroneb Pro^a	Heparin increased the number of ventilator-free days; P/F ratio and mortality were unaffected. There was a trend for less tracheotomies with heparin. The incidence of systemic bleeding was not affected; heparin increased APTT.	Dixon [15]
Heparin + N-acetylcysteine + albulterol	Case control study of 30 patients after smoke inhalation 10,000 U 6 dd for 7 days Nebulizer not stated	Heparin + acetylcysteine + albulterol improved survival and lung injury score. Effects on systemic coagulation and systemic bleeding were not reported.	Miller [45]
Heparin	Phase 1 trial of 16 patients with ALI 50-400 × 10³ U/day for 2 days Aeroneb Pro^a	Heparin attenuated pulmonary coagulation; P/F ratio and lung compliance were not affected. Heparin increased APTT. The incidence of systemic bleedings was not affected.	Dixon [43, 44]

See original manuscript for details. ^aAerogen, Galway, Ireland. ALI: acute lung injury; APTT, activated partial thromboplastin time; MV, mechanical ventilation; RCT, randomized controlled trial.

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