Heparin in the treatment of burns: a review

Burns are difficult to treat, wounds with complex local and systemic pathology and high mortality, that often heal slowly with scars and contractures. Glycosaminoglycans (GAGs) have been used in parenteral and topical application studies. These studies have uncovered anticoagulative, antiinflammatory and neoangiogenic properties, which may stimulate tissue repair and reepithelializing effects. The endogenous GAGs utilized in treating burns are heparin, dermatan sulfate, heparan sulfate, keratin sulfate, chondroitin-4- and chondroitin-6-sulfate, and hyaluronic acid. Heparin, the most sulfated and acidic GAG, has been used parenterally, topically, by inhalation, in pellet, and in bioengineered membranes. Heparin relieved pain, inhibited clotting and inflammation, restored blood flow, and enhanced healing. Heparin effects that improved and reduced burn care were time, dose, pH, site, source and duration related in studies. Potential adverse effects with heparin use are bleeding, thrombocytopenia and allergy. Heparin preserved lung and improved function. Heparin preserved intestinal integrity and reduced bacterial translocation. Collagen restoration was enhanced. The healed skin was smooth. Heparin reduced needs for pain medicine, topical antibiotics, resuscitation fluids, blood, water baths, debridement, surgery and grafts. Cost of treatments were reduced. Although not as yet fully substantiated, topical heparin therapy of burns may be a useful addition to the range of available treatments for burn wounds.