Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials.
OBJECTIVE
To evaluate the effect of heparin on thrombus formation and infection associated with use of central venous and pulmonary artery catheters.


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


METHODS
Fourteen randomized controlled trials evaluating prophylactic doses of heparin or heparin bonding were included.


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


RESULTS
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.
Randolph
A G
AG
Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, USA.
Cook
D J
DJ
Gonzales
C A
CA
Andrew
M
M
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002407:Catheterization, Swan-Ganz / Q000295:instrumentation*; D002648:Child; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D016239:MEDLINE; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013924:Thrombophlebitis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States
D000925:Anticoagulants; D006493:Heparin