Frontiers in medicine · 2026
Early systemic heparin exposure is associated with lower mortality, reduced disseminated intravascular coagulation, and fewer thrombotic complications in septic shock.
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Radermacher Philipp Bernd, Fujita Buntaro, Vahldieck Carl
Аннотация
INTRODUCTION: Septic shock is characterized by thrombo-inflammatory dysregulation and disseminated intravascular coagulation (DIC), contributing to organ failure and mortality. The clinical impact of heparin in septic shock remains uncertain. This study evaluated the association between early systemic heparin exposure and clinical outcomes.
METHODS: A retrospective multicenter cohort study was conducted using the TriNetX federated electronic health record network. Adult patients with septic shock receiving early systemic heparin exposure were compared with patients without heparin exposure. Propensity score matching balanced demographics, comorbidities, infection characteristics, organ dysfunction markers, and severity-related variables. Outcomes included mortality, DIC, thrombotic complications, renal outcomes, hematologic complications, and bleeding-related events. Clinical outcomes were assessed over a predefined 30-day follow-up period using risk-based and time-to-event analyses.
RESULTS: A total of 105,472 patients per cohort were included. Early systemic heparin exposure was associated with lower mortality (15.3% vs. 20.8%; p < 0.001) and lower rates of DIC (p < 0.001). Thrombotic complications, including ischemic stroke, acute myocardial infarction, overall thrombotic events, and arterial or venous thrombosis, occurred less frequently among heparin-exposed patients (all p < 0.001). In contrast, heparin exposure was associated with higher rates of acute kidney injury, renal replacement therapy, thrombocytopenia, major bleeding, and transfusion requirement (all p < 0.01). Kaplan-Meier analyses were consistent with risk-based analyses.
DISCUSSION: Early systemic heparin exposure was associated with lower mortality, reduced DIC, and fewer thrombotic complications, but increased rates of renal dysfunction and bleeding-related adverse events. These findings highlight a clinically relevant trade-off between potential benefit and harm. Prospective randomized studies are needed to define optimal patient selection and treatment timing.
METHODS: A retrospective multicenter cohort study was conducted using the TriNetX federated electronic health record network. Adult patients with septic shock receiving early systemic heparin exposure were compared with patients without heparin exposure. Propensity score matching balanced demographics, comorbidities, infection characteristics, organ dysfunction markers, and severity-related variables. Outcomes included mortality, DIC, thrombotic complications, renal outcomes, hematologic complications, and bleeding-related events. Clinical outcomes were assessed over a predefined 30-day follow-up period using risk-based and time-to-event analyses.
RESULTS: A total of 105,472 patients per cohort were included. Early systemic heparin exposure was associated with lower mortality (15.3% vs. 20.8%; p < 0.001) and lower rates of DIC (p < 0.001). Thrombotic complications, including ischemic stroke, acute myocardial infarction, overall thrombotic events, and arterial or venous thrombosis, occurred less frequently among heparin-exposed patients (all p < 0.001). In contrast, heparin exposure was associated with higher rates of acute kidney injury, renal replacement therapy, thrombocytopenia, major bleeding, and transfusion requirement (all p < 0.01). Kaplan-Meier analyses were consistent with risk-based analyses.
DISCUSSION: Early systemic heparin exposure was associated with lower mortality, reduced DIC, and fewer thrombotic complications, but increased rates of renal dysfunction and bleeding-related adverse events. These findings highlight a clinically relevant trade-off between potential benefit and harm. Prospective randomized studies are needed to define optimal patient selection and treatment timing.