Safety Of Heparin In Patients Research Articles

Adjuvant therapy with heparin in patients with lung cancer without indication for anticoagulants: A systematic review of the literature with meta-analysis.

The effect of heparin in improving cancer survival has gained increasing attention over the past decades. Several clinical trials have evaluated the role of heparin on survival outcome and its safety profile in lung cancer patients. Thus, we performed a systematic review and meta-analysis from the results of randomized controlled trials (RCTs) to assess the efficacy and safety of heparin in patients with lung cancer without indication for anticoagulants. We searched PubMed, Embase, and The Cochrane Central Register of Controlled Trials databases for relevant studies. The inclusion criteria used were patients with lung cancer without a concurrent diagnosis of venous thromboembolism (VTE) and were treated with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). The outcomes included survival outcome, VTE, bleeding, major bleeding, and thrombocytopenia. The results were presented as hazard ratio (HR) and relative risk (RR), and the STATA 12.0 package was used for comprehensive quantitative analysis. A total of 6 studies with 753 cases and 640 controls were included for the final analysis. The meta-analysis showed significant differences in survival with an HR of 0.71 (95% confidence interval [CI] 0.60-0.84), particularly in limited-stage small cell lung cancer (SCLC) with an HR of 0.57 (95% CI 0.43-0.77), and also in VTE (RR 0.46; 95% CI 0.27-0.80) when heparin was compared with placebo or no anticoagulant. There were no significant differences in risks for bleeding (RR 1.53; 95% CI 0.96-2.45), major bleeding (RR 1.43; 95% CI 0.59-3.45), and thrombocytopenia (RR 0.86; 95% CI 0.66-1.12). Administration of heparin (mainly LMWH) as primary thromboprophylaxis for lung cancer patients without indication for anticoagulants was associated with a significant survival benefit, particularly in limited-stage SCLC.

The efficacy and safety of heparin in patients with sepsis: a systematic review and metaanalysis.

To evaluate the efficacy and safety of heparin in patients with sepsis, septic shock, or disseminated intravascular coagulation associated with infection. Systematic review and metaanalysis. Randomized controlled trials from MEDLINE, EMBASE, CENTRAL, Global Health, Scopus, Web of Science, the International Clinical Trials Registry Platform (inception to April 2014), conference proceedings, and reference lists of relevant articles. Two reviewers independently identified and extracted trial-level data from randomized trials investigating unfractionated or low molecular heparin administered to patients with sepsis, severe sepsis, septic shock, or disseminated intravascular coagulation associated with infection. Internal validity was assessed in duplicate using the Risk of Bias tool. The strength of evidence was assessed in duplicate using Grading of Recommendations Assessment, Development, and Evaluation methodology. Our primary outcome was mortality. Safety outcomes included hemorrhage, transfusion, and thrombocytopenia. We included nine trials enrolling 2,637 patients. Eight trials were of unclear risk of bias and one was classified as having low risk of bias. In trials comparing heparin to placebo or usual care, the risk ratio for death associated with heparin was 0.88 (95% CI, 0.77-1.00; I2 = 0%; 2,477 patients; six trials; moderate strength of evidence). In trials comparing heparin to other anticoagulants, the risk ratio for death was 1.30 (95% CI, 0.78-2.18; I2 = 0%; 160 patients; three trials; low strength of evidence). In trials comparing heparin to placebo or usual care, major hemorrhage was not statistically significantly increased (risk ratio, 0.79; 95% CI, 0.53-1.17; I2 = 0%; 2,392 patients; three trials). In one small trial of heparin compared with other anticoagulants, the risk of major hemorrhage was significantly increased (2.14; 95% CI, 1.07-4.30; 48 patients). Important secondary and safety outcomes, including minor bleeding, were sparsely reported. Heparin in patients with sepsis, septic shock, and disseminated intravascular coagulation associated with infection may be associated with decreased mortality; however, the overall impact remains uncertain. Safety outcomes have been underreported and require further study. Increased major bleeding with heparin administration cannot be excluded. Large rigorous randomized trials are needed to evaluate more carefully the efficacy and safety of heparin in patients with sepsis, severe sepsis, and septic shock.

Efficacy and safety of heparin in patients with sepsis: a systematic review and meta-analysis

Septic shock is characterized by systemic inflammation coupled with upregulation of coagulation. Heparin is an inexpensive and widely available anticoagulant with anti-inflammatory properties. The objectives our study were to evaluate the efficacy and safety of heparin in patients with sepsis, septic shock or disseminated intravascular coagulation (DIC) associated with infection.

Safety of perioperative minidose heparin in patients undergoing brain tumor surgery: a prospective, randomized double-blind study.

Safety of perioperative minidose heparin in patients undergoing brain tumor surgery: a prospective, randomized double-blind study.