The Effect of Heparin and Its Preparations on Disseminated Intravascular Coagulation Mortality and Hospitalization: A Systematic Review

Abstract

Background and Aim. Disseminated intravascular coagulation (DIC) is a critical clinical condition that is expressed by systemic activation of the homeostatic system, leading to elevation of thrombin deposition and result in microvascular thrombi. Heparin makes a good effect on hypercoagulability states through inhibition of thrombin. The present study aimed to summarize and discuss the results of randomized clinical trials and cohort studies regarding the effect of heparin and its preparations on DIC mortality and duration of hospitalization. Methods. The databases of PubMed, Scopus, Embase, and Web of Science were searched systematically up to November 2021. The quality of RCTs was assessed by Cochrane Collaboration’s tool and the risk of bias was assessed for cohort studies through NOS score. Results. Out of 3288 articles, eight studies were eligible to be included in this study. Our review retrieved six RCTs and two retrospective cohort studies consisting of 950 participants diagnosed by DIC. A significant effect of heparin on DIC mortality was identified in four studies. Furthermore, heparin was used as a control group in three studies. Conclusions. We concluded that administration of heparin and its preparations in DIC patients could reduce the mortality rate and duration of hospitalization, especially in the earlier stages of DIC.

Heparins May Not Be the Optimal Anticoagulants for Sepsis and Sepsis-Associated Disseminated Intravascular Coagulation

“…Following these studies, Omidkhoda et al 23 performed a meta-analysis of the six RCTs and two cohort studies that examined heparins' effects on DIC from various underlying diseases. Although reduced mortality by UFH or LMWH was reported, five studies targeted or included sepsis cases, and heparins were used as the control of the study drugs in four studies.…”

The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation

“…However, little evidence supports the efficacy of anticoagulant therapy in addition to antibiotics and source control. Despite studies of several anticoagulants in large-scale randomized controlled trials (RCTs), no current anticoagulant has yet demonstrated efficacy [ 61 , 63 ]. Potential reasons include the variability of clinical presentation in sepsis [ 61 ], but as previously described, anticoagulant therapy should be considered only for patients with a coagulation disorder, as best noted the optimal target is sepsis-associated DIC with high disease severity [ 38 , 39 ] (Fig.…”

“…However, the study population was not restricted to patients with coagulopathy/DIC. Another systematic review of heparin in DIC [ 63 ] was limited by including studies in which three out of eight studies used heparin as the control. Although heparin is strongly recommended for COVID-19 [ 64 ], its efficacy for sepsis-associated DIC is still unclear.…”

Coagulopathy and adverse outcomes in hospitalized patients with COVID-19: results from the NOR-Solidarity trial

“…Although several studies have addressed the association between coagulation parameters and disease severity in the acute phase of COVID-19, data on the relationship of these parameters to long-term outcome are scarcer. Moreover, while the effects of various anticoagulants have been reported in several studies [ 13 , 14 ], the impact of antiviral agents on these variables is not known.…”