Activated protein C decreases mortality in patients with sepsis and a high risk of death due to its anticoagulant and anti-inflammatory properties. Why not something cheaper that does the same thing? In this study unfractionated heparin decreased mortality in the most severely ill patients (APACHE II 29-53) with septic shock. It’s not ready for prime time and the findings need more validation. It was not a RCT, but rather a propensity matched retrospective study. Although patients with an admitting diagnosis of acute coronary syndrome or pulmonary embolism were excluded, many patients in the treatment group had their heparin started because of an elevated troponin level or clinical suspicion or VTE.
Editorial comment here.