Open Access

Can heparin therapy reduce 28-day mortality in adult severe sepsis patients?

Contributed equally
Critical Care201519:66

https://doi.org/10.1186/s13054-015-0768-1

Published: 19 February 2015

A study by Wang and colleagues [1] in a previous issue of Critical Care shows that heparin may reduce 28-day mortality in severe sepsis patients without causing an increased risk of bleeding. Therefore, the authors recommend the use of heparin for sepsis and severe sepsis. Although their result may significantly influence clinical practice, several confounding factors should be noticed.

In this study, eight studies performed analyses of mortality and seven studies performed analyses of bleeding events. From Additional file two, three non-randomized controlled trials (NRCTs) account for 88.42% of weight on mortality [2-4]; and from Figure three, two NRCTs account for 92.27% of weight on bleeding events [2,3]. In other words, the results of this meta-analysis are almost equivalent to those of the meta-analysis of these five NRCTs. Given the above analysis, the subgroup analyses in this study were unnecessary. However, the three studies were only placebo groups in three large multi-center randomized controlled trials [2-4]. Patients in these placebo groups were not randomly assigned to receive heparin or other therapy. In addition, it is possible that patients receiving heparin were less severe, because the Acute Physiology and Chronic Health Evaluation II score was not reported in these placebo groups. Moreover, as the initial times of heparin treatment were not defined clearly in the above three studies, we cannot rule out the possibility that patients who had died early would have no chance to receive heparin, whereas patients who had a longer survival would be more inclined to receive heparin. Finally, the dose of heparin in the three trials, and within each trial, was not controlled.

Notes

Abbreviation

NRCT: 

Non-randomized controlled trial

Declarations

Authors’ Affiliations

(1)
Department of Emergency Medicine, Second Affiliated Hospital, School of Medicine & Institute of Emergency Medicine, Zhejiang University
(2)
The Second Department of Respiration, Affiliated Hospital of Zunyi Medical College

References

  1. Wang C, Chi C, Guo L, Wang X, Guo L, Sun J, et al. Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis. Crit Care. 2014;18:563.View ArticlePubMed CentralPubMedGoogle Scholar
  2. Warren BL, Eid A, Singer P, Pillay SS, Carl P, Novak I, et al. Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA. 2001;286:1869–78.View ArticlePubMedGoogle Scholar
  3. Abraham E, Reinhart K, Opal S, Demeyer I, Doig C, Rodriguez AL, et al. Efficacy and safety of tifacogin (recombinant tissue factor pathway inhibitor) in severe sepsis: a randomized controlled trial. JAMA. 2003;290:238–47.View ArticlePubMedGoogle Scholar
  4. Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, et al. Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group: efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001;344:699–709.View ArticlePubMedGoogle Scholar

Copyright

© Jiang et al.; licensee BioMed Central. 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement