Effects of heparin on venom-induced consumption coagulopathy: a meta-analysis of randomized controlled trials

Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebites, potentially leading to life-threatening bleeding. Despite efforts to determine effective treatments other than antivenom, such as heparin, the evidence supporting their use remains insufficient. Therefore, this study aimed to perform a systematic review, meta-analysis and trial sequential analysis (TSA) to examine the effects of heparin on VICC. On 11 August 2024, a systematic search for randomized controlled trials (RCTs) investigating the effects of heparin on VICC was conducted using eight online databases. Six RCTs were included in this study. The meta-analysis revealed that heparin did not significantly reduce the mortality rate (risk ratio, 0.65; 95% CI 0.39 to 1.10). Additionally, the meta-analysis showed no significant differences in various clinical outcomes between the heparin group and control group. The TSA indicated insufficient evidence to conclude the effects of heparin on VICC mortality, and a sample size of 741 patients may be needed for further RCTs. In conclusion, our findings indicate that heparin may not significantly affect VICC outcomes. Although the current evidence is inconclusive because of the limited sample size, it highlights the need for future trials to provide more precise insights.