title: Safety and potential anticoagulant effects of nebulised heparin in burns patients with inhalational injury at Singapore General Hospital Burns Centre.
abstract: BACKGROUND
  Nebulised heparin, N-acetylcysteine (NAC) and salbutamol were shown to decrease reintubation rates, incidence of atelectasis and mortality in paediatric patients and reduce lung injury scores in adult burns patients with inhalational lung injury (ILI). Nebulised heparin, NAC and salbutamol treatment protocol was introduced in Singapore General Hospital (SGH) Burns Centre in 2006. However, safety data on the use of nebulised heparin and NAC for burns patients with ILI is not well established. In this study, we investigated the safety and potential anticoagulant effects of nebulised heparin in burns patients with ILI.
  
  
  METHODS
  A retrospective study with historical control was conducted. The treatment group consisted of 52 mechanically ventilated adult patients, with a diagnosis of ILI as confirmed by bronchoscopy, admitted to burn intensive care unit (BICU) from the year 2006 to 2009. The group was treated with nebulised heparin, NAC and salbutamol. The control group consists of 11 mechanically ventilated BICU ILI patients treated from year 2001 to 2005 before protocol initiation. Blood coagulation indices (prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet count) were monitored and bleeding incidences were assessed.
  
  
  RESULTS
  Blood coagulation indices did not suggest an increase risk of bleeding with nebulised heparin. The APTT, PT and platelet count followed a similar trend for both groups over 7 days. No clinically significant increase in bleeding risk was found to be associated with nebulised heparin.
  
  
  CONCLUSIONS
  Nebulised heparin was not found to potentiate the risk of bleeding in burns patients with ILI.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore. a0026848@nus.edu.sg
authors.forename: Lian Yee
authors.initials: LY
authors.lastname: Yip
authors.forename: Yen Fang
authors.initials: YF
authors.lastname: Lim
authors.forename: Hong Ngee
authors.initials: HN
authors.lastname: Chan
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001780:Blood Coagulation Tests; D002056:Burns / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011516:Prothrombin / Q000032:analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012846:Singapore; D015208:Smoke Inhalation Injury / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D011516:Prothrombin; D006493:Heparin