Science of Heparin in Treatment of Burns

  

Burns are very painful thermal injuries that directly damage skin and deeper structures and result in: 

  • Slowing of blood flow (stasis) and formation of blood clots (thrombi) that can break off and travel within blood vessels (emboli), or block blood flow to a tissue area (infarction), which results in the progressive cascading destruction (inflammation), loss and death (necrosis) and casting off (slough) of that specific tissue or of many body tissues and multiple organs (disseminated intravascular coagulopathy, named the DIC Syndrome). 
  • A progressive cascading destruction (inflammation due to biochemical mediators such as histamine, serotonin, proteolytic enzymes and many others) of all of the burned cells, and many initially non-burned cells (a morbid pathophysiology) which results in pain, (dolor), swelling (tumor), redness (rubor), heat (calor), and loss of function, all of which increases the need for pain medicine, fluids, blood, antibiotics, burn care, and surgery with incisions, debridements, and skin grafts. 
  • A high death rate (increased mortality). 
  • Slow healing or non-healing of the injured tissue. 
  • Residual scars and restrictions in movement that limit function (contractures). 
  • Great difficulty in the treatment of the burns and associated high costs. 

 

How do doctors view heparin in biochemical terms? 

Heparin is a natural biochemical found in the body of humans and animals. It is a long chain compound of two highly sulfonated sugars. This highly reactive, most acidic body substance is classified as a glucosaminoglycan. It was first extracted from the liver (the hepar organ) in 1916, isolated in pure form by 1935, and predominantly used since as an anti-coagulating medicine. 

Since 1960, other effects of heparin have been uncovered and utilized in burn and non-burn studies and in burned patients by Dr. Saliba, his associates and other researchers. Heparin is now known to have additional effects. Doctors reason that heparin’s known effects are a therapeutic match for the known pathology of burns. Research studies and clinical trials have validated that assumption. 

To SBI’s knowledge, no negative studies or trials using heparin in burned humans have been reported or published. 

What are the effects of heparin in burn care? 

Studies have demonstrated that heparin used topically, parenterally, and by inhalation in adequately large doses, starting early in burn care at acidic pHs and then continuing topically into final healing produced effects which are: 

ANTI-COAGULATING, preventing blood stasis and blood clots, and limiting tissue ischemia and tissue infarctions with cellular necrosis and cell death. 

ANTI-INFLAMMATORY, reversibly combining with and neutralizing most of the mediators of inflammation at acidic pH, early postburn. This would tend to prevent burn extension, common without heparin, which is not present when heparin is used. With heparin use, initial size and depth are usually maximum size. In controlled studies, untreated 3rd degree burns increased in size and depth for 9 to 11 days. Heparin-treated burns diminished in size. Anti-inflammatory effects would limit or stop the signs and symptoms of inflammation: pain, swelling, redness, and heat. This is the common experience with heparin use: consistently no pain medications are required. The reduced tissue swelling usually does not require releasing surgical incisions called escarotomies and fasciectomies; the volume of resuscitation fluid needed is significantly reduced; the initial burn redness blanches with heparin use. And, although it is not of clinical importance, the burns are cooler. 

NEOANGIOGENIC, stimulating the migration of capillary endothelial cells into ischemic, blood deficient tissue; and the multiplication of those cells to form new capillary blood vessels which, when reperfused with blood, reestablishes and restores blood flow. 

TISSUE RESTORING, which accelerates granulation healing partly through COLLAGEN REGULATION, which heparin initially accelerates and later decelerates. This improves healing and helps limit fibrin buildup deposits. 

REEPITHELIALIZING, stimulating proliferation of dermal fibroblasts, new skin cells, and aligning their intracytoplasmic fibrils into regular patterns throughout the cell. This results in smooth, comfortable, functional new skin instead of the scars that result when the fibrils are in chaotic clumps under the cell membrane. Individuals who have genetic tendency to keloid formation may have a few isolated areas of keloid, which is under study now. 

SMOOTH MUSCLE CELL REGULATING, limiting contractions by controlling clumping of smooth muscle cells, thereby preventing distortion of the healed skin. 

Heparin cannot be used in burned persons who have a contraindication: active bleeding, trauma with potential for bleeding, a personal or familial bleeding tendency, an active gastrointestinal ulcer, a thrombocytopenia, or a true allergy to heparin. 

Well-controlled studies using heparin in burned subjects have found that heparin: 

  • Preserved lung tissue, improved lung function and reduced mortality. 
  • Preserved intestinal structure and reduced translocation of bacteria from the gut into the body. 
  • Reduced mortality and sepsis in severely burned children and adults. 

 

Pediatric patients stop crying and struggling because they are free of pain and not subjected to onerous and bewildering medical procedures. 

When heparin is in use, a burn ward has a pleasant ambience, with calmer patients and non-stressed caregivers. There is reduced suffering and mortality. There are fewer procedures and they are simpler and easier to do. The patient’s hospital stay is greatly shortened and the costs are dramatically reduced. 

The SBI burn treatment protocol has been used by burn specialists in the U.S., India, Russia, China, Bulgaria, El Salvador, Brazil, Mexico, Haiti, Oman, South Korea, Nepal, Italy, Paraguay, Belgium, Peru, Chile, South Africa. 


Now is the time to broadly: 

  1. Inform the medical profession and the general public about the benefits of this affordable burn treatment and promote its use in the U.S. and other countries. 
  2. Instruct those who handle thermal incidents and those who treat burn victims in the protocol.