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Benefit of Heparin in Central Venous and Pulmonary Artery Catheters : A Meta-analysis of Randomized Controlled Trials

Adrienne G. Randolph; Deborah J. Cook; Calle A. Gonzales; Maureen Andrew
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Affiliations: From the Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston,  From the Departments of Clinical Epidemiology and Biostatistics and Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada,  From the Department of Pediatrics, Division of Pediatric Critical Care, University of California, San Francisco,  From the Department of Pediatrics, Division of Pediatric Hematology, McMaster University, Hamilton, Ontario, Canada

Affiliations: From the Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston,  From the Departments of Clinical Epidemiology and Biostatistics and Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada,  From the Department of Pediatrics, Division of Pediatric Critical Care, University of California, San Francisco,  From the Department of Pediatrics, Division of Pediatric Hematology, McMaster University, Hamilton, Ontario, Canada

Affiliations: From the Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston,  From the Departments of Clinical Epidemiology and Biostatistics and Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada,  From the Department of Pediatrics, Division of Pediatric Critical Care, University of California, San Francisco,  From the Department of Pediatrics, Division of Pediatric Hematology, McMaster University, Hamilton, Ontario, Canada

Affiliations: From the Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston,  From the Departments of Clinical Epidemiology and Biostatistics and Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada,  From the Department of Pediatrics, Division of Pediatric Critical Care, University of California, San Francisco,  From the Department of Pediatrics, Division of Pediatric Hematology, McMaster University, Hamilton, Ontario, Canada


1998 by the American College of Chest Physicians


Chest. 1998;113(1):165-171. doi:10.1378/chest.113.1.165
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Published online

Abstract

Objective: To evaluate the effect of heparin on thrombus formation and infection associated with use of central venous and pulmonary artery catheters.

Data sources: We used MEDLINE, EMBASE, citation review of relevant primary and review articles, personal files, and contact with expert informants.

Study selection: Fourteen randomized controlled trials evaluating prophylactic doses of heparin or heparin bonding were included.

Data extraction: In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality.

Data synthesis: Prophylactic heparin decreases catheter-related venous thrombosis (relative risk [RR], 0.43; 95% confidence interval [CI], 0.23, 0.78) and bacterial colonization (RR, 0.18; 95% CI, 0.06, 0.60) of central venous catheters and may decrease catheter-related bacteremia (RR, 0.26; 95% CI, 0.07, 1.03). Heparin bonding decreases the risk of pulmonary artery catheter clot formation within 24 h (RR, 0.08; 95% CI, 0.02, 0.37).

Conclusions: Heparin administration effectively reduces thrombus formation and may reduce catheter-related infections in patients who have central venous and pulmonary artery catheters in place. Cost-effectiveness comparisons of unfractionated heparin, low molecular weight heparin, and warfarin are needed.


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