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.

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.