Topical Heparin in Burns: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Abstract

Burns are associated with significant inflammation and pain. Topical agents like heparin can modulate these processes and improve outcomes. Our study aims to evaluate the effectiveness of using topical heparin (TH) in patients with burns. On August 7, 2024, we conducted a literature search on PubMed, Scopus, and Web of Science. Only randomized controlled studies were included. Data were extracted on analgesic drug usage, bleeding events, sepsis, visual analog scale pain scores, length of hospital stay, and mortality. Statistical analysis was performed using R software (version 4.4.1), heterogeneous data. Seven randomized controlled trials (503 patients; topical heparin: 249, control: 254) were included. Analgesic use (1-2 times/day: RR = 3.04, P = .68; 3-4 times/day: RR = 0.06, P = .18), bleeding (RR = 5.06, P = .37), sepsis (RR = 0.77, P = .40), hospital stay, and mortality (RR = 0.13, P = .90) showed no significant differences. Topical heparin reduced local wound infections by 60% (RR = 0.40, P < .01) and lowered Visual Analog Scale pain scores (MD = -3.34, P < .01). However, sensitivity analysis excluding an outlier nullified the pain reduction (MD = -4.17, P = .57). All studies had a high risk of bias, especially in outcome measurement and randomization. Topical heparin reduces pain and local wound infections in burn patients without having an impact on other outcomes. Evidence is limited by a high risk of bias. Well-designed randomized trials are needed to determine its broader clinical value.