title: Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomized controlled trials.
abstract: 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.
authors.affiliation: Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Randolph
authors.forename: D J
authors.initials: DJ
authors.lastname: Cook
authors.forename: C A
authors.initials: CA
authors.lastname: Gonzales
authors.forename: M
authors.initials: M
authors.lastname: Andrew
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006493:Heparin