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The Uses of Heparin To Treat Burn Injury
Evidence Reports/Technology Assessments, No. 148
Mark Oremus, PhD, Mark Hanson, MD, MEd, FRCPC, Richard Whitlock, MD, MSc, Ed Young, PhD, Alok Gupta, MS, Arianna Dal Cin, MD, BSc, FRCSC, Carolyn Archer, MSc, and Parminder Raina, PhD.
Structured Abstract
Objectives:
To assess the evidence for using heparin in the treatment of burn injury or the complications of burn injury in adults and children.
Data Sources:
The following databases were searched: MEDLINE® (1966-current), EMBASE (1980-current), Cumulative Index to Nursing & Allied Health (CINAHL) (1982-current), The Cochrane Central Database of Controlled Trials (1995-current), Web of Science (1976-current), and BIOSIS (1976-current). Additional data sources included the U.S. and European Patent Offices, technical experts, the partner organization, and reference lists.
Review Methods:
Studies identified from the data sources went through two levels of title and abstract screening. Passing studies advanced to full text screening. Studies that met the full text screening criteria were abstracted. Criteria for abstraction included publication in any language, human patients of any age, and burns of any type, grade, or total body surface area. All formulations of heparin, and all application methods (e.g., topical, subcutaneous), were eligible for inclusion in the report. Abstracted studies required a comparison group. Outcomes of interest included mortality, pain, length of stay in hospital, thrombosis and emboli, psychiatric adjustment, and adverse effects (e.g., bleeding).
Results:
Nineteen articles from 18 unique studies were abstracted and included in this report. In these articles, there were multiple uses of heparin to treat burns (e.g., wound healing, inhalation injury, sepsis, pain). However, the overall quality of the articles was weak. Examples of weakness included unclear or inappropriate treatment allocation, no blinding, no control of confounding, poorly defined burn characteristics (e.g., thickness), unclear duration of treatment, incomplete description of heparin treatment, and use of inadequately described or invalid outcome measures. Overall, the evidence from these weak articles was insufficient to determine whether the effectiveness of heparin to treat burn injury was different from the effectiveness of other treatments, or whether treatment effectiveness varied according to (a) the method of applying heparin to (b) burn etiology.
Four studies mentioned contraindications to using heparin to treat burns. These contraindications were bleeding diathesis, bleeding history, active bleeding or associated trauma with potential bleeding, active intestinal ulcer, thrombocytopenia, liver disease, renal disorders, or allergy to heparin.
Conclusion:
There is no strong evidence in the 19 abstracted articles to suggest that heparin should be used in the treatment of burn injury on account of its non-anticoagulant properties. However, since the lack of evidence is largely a function of the poor quality of the articles, further research is needed to investigate the potential uses of heparin in the treatment of burn injury.
Contents
Task Order Leaders: Mark Oremus, PhD and Mark Hanson, MD, MEd, FRCPC.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0020. Prepared by: McMaster University Evidence-based Practice Center, Hamilton, Ontario, Canada.
Suggested citation:
Oremus M, Hanson M, Whitlock R, Young E, Gupta A, Dal Cin A, Archer C, Raina P. The Uses of Heparin To Treat Burn Injury. Evidence Report/Technology Assessment No. 148. (Prepared by the McMaster University Evidence-based Practice Center, under Contract No. 290-02-0020). AHRQ Publication No. 07-E004. Rockville, MD: Agency for Healthcare Research and Quality. December 2006.
This report is based on research conducted by the McMaster University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0020). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
Dr. Young is affiliated with the Henderson Research Center, which has interests in Heparin. Drs. Oremus, Hanson, Whitlock, Gupta, Dal Cin, and Raina have no financial interest in this field, nor does Ms. Archer.
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- Review A systematic review of heparin to treat burn injury.[J Burn Care Res. 2007]Review A systematic review of heparin to treat burn injury.Oremus M, Hanson MD, Whitlock R, Young E, Archer C, Dal Cin A, Gupta A, Raina P. J Burn Care Res. 2007 Nov-Dec; 28(6):794-804.
- Nebulized heparin for inhalation injury in burn patients: a systematic review and meta-analysis.[Burns Trauma. 2020]Nebulized heparin for inhalation injury in burn patients: a systematic review and meta-analysis.Lan X, Huang Z, Tan Z, Huang Z, Wang D, Huang Y. Burns Trauma. 2020; 8:tkaa015. Epub 2020 Jun 4.
- Evidence-based emergency medicine: clinical synopsis. No clear winner among dressings for partial-thickness burns.[Ann Emerg Med. 2010]Evidence-based emergency medicine: clinical synopsis. No clear winner among dressings for partial-thickness burns.Oostema JA, Ray DJ. Ann Emerg Med. 2010 Sep; 56(3):298-9. Epub 2010 May 10.
- Review Evidence based evaluation of immuno-coagulatory interventions in critical care.[Dan Med Bull. 2011]Review Evidence based evaluation of immuno-coagulatory interventions in critical care.Afshari A. Dan Med Bull. 2011 Sep; 58(9):B4316.
- Review Heparin in the treatment of burns: a review.[Burns. 2001]Review Heparin in the treatment of burns: a review.Saliba MJ Jr. Burns. 2001 Jun; 27(4):349-58.
- The Uses of Heparin To Treat Burn InjuryThe Uses of Heparin To Treat Burn Injury
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