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Semin Thromb Hemost 2024; 50(07): 1012-1018
DOI: 10.1055/s-0044-1786754
Commentary

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

Toshiaki Iba 
1   Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
,
Julie Helms 
2   Strasbourg University Hospital, Medical Intensive Care Unit - NHC, INSERM (French National Institute of Health and Medical Research), Strasbourg University (UNISTRA), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
,
Takaaki Totoki 
3   Department of Anesthesiology and Critical Care Medicine, Kyushu University, Fukuoka, Japan
,
Jerrold H. Levy 
4   Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina
› Author Affiliations Funding This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.
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Abstract

Historically, heparin has had the longest historical use as an anticoagulant and continues this day to be the primary therapeutic option for preventing thrombosis and thromboembolism in critically ill hospitalized patients. Heparin is also used to treat sepsis and sepsis-associated disseminated intravascular coagulation (DIC) in various countries. However, the efficacy and safety of heparin for this indication remains controversial, as adequately powered randomized clinical studies have not demonstrated as yet a survival benefit in sepsis and sepsis-associated DIC, despite meta-analyses and propensity analyses reporting improved outcomes without increasing bleeding risk. Further, activated protein C and recombinant thrombomodulin showed greater improvements in outcomes compared with heparin, although these effects were inconclusive. In summary, further research is warranted, despite the ongoing clinical use of heparin for sepsis and sepsis-associated DIC. Based on Japanese guidelines, antithrombin or recombinant thrombomodulin may be a preferable choice if they are accessible.

Keywords

heparin - low-molecular-weight heparin - anticoagulants - sepsis - disseminated intravascular coagulation

Authors' Contributions

All authors met authorship criteria and participated significantly in the study. T.I. and T.T. wrote the draft. J.H. and J.H.L. reviewed and revised the manuscript. All authors read and approved the final manuscript.




Publication History

Article published online:
11 May 2024

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