Dear Editors

Regarding the article published in December 2007 in Annals of Burns and Fire Disasters, vol. 20, no. 4, pp. 189-98, entitled “A comparative study of burns treated with topical heparin and without heparin”, by Venakatachalapathy T.S., Mohan Kumar S., Saliba M.J., I would like to make a number of observations.

In an extensive review about the uses of heparin to treat burn injury conducted by the McMaster University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ) with a multidisciplinary expert panel,1 a small number of poorly designed studies were identified. These studies did not offer strong evidence that the use of heparin could lead to better clinical outcome in burn care.2 To my knowledge this is the first seriously conducted prospective comparative study offering substantial evidence about the benefits of topical treatment of burn wounds with heparin.

The first consecutive 100 patients aged 15-35 yr whose superficial and deep second-degree severity burns were below 50% TBSA size (range, 5-45%) admitted to Indira Gandhi Government General Hospital and Postgraduate Institute, Burns Unit, Pondicherry, India, were included in this study. Fifty of these patients were designated to be the control group (C) and received the traditional routine treatment in addition to topical antimicrobial sulphur-base cream. The other fifty patients were assigned to the heparin-treated group (H) and received the same treatment but without the use of topical antimicrobial creams. Sodium aqueous heparin solution USP from a bovine intestinal mucosa source was applied instead in a well-standardized and controlled protocol.3 Unfortunately, the authors did not specify how these 100 patients were distributed among the two study groups. It is unfortunate also that the two groups are not comparable with regard to burn extent since more patients in the control group had burns > 36-50% TBSA, which may have introduced some bias in outcome assessment.

Irrespectively, this study offers the best evidence to date about the effectiveness of topical heparin in burn treatment. The authors must be commended for their work and for the meticulous reporting of their results. It would be worthwhile though that they review the outcome of the two groups and report again the results of their comparative study excluding the patients with burns > 36-50% TBSA so that the two groups become comparable with respect to burn extent. This will make their conclusions more valuable.

Yours sincerely
Bishara S. Atiyeh, MD, FACS
General Secretary, Mediterranean Council for Burns
and Fire Disasters, Clinical Professor,
Plastic and Reconstructive Surgery,
American University of Beirut Medical Center,
Beirut, Lebanon
aata@terra.net.lb

Bibliography

1. Oremus M., Hanson M., Whitlock R., Young E., Gupta A., Dal Cin A., Archer C., Raina P.: The uses of heparin to treat burn injury. Evidence Report/Technology Assessment No. 148. (Prepared by the McMaster University Evidence-based Practice Center, under Contract No. 290-02-0020). AHRQ Publication No. 07-E004. Rockville, MD: Agency for Healthcare Research and Quality. December 2006.
2. Atiyeh B.S.: Letter to the Editors: A systemic review of the uses of heparin to treat burn injury. Ann. Burns Fire Disasters, 20: 46-7, 2007.
3. Venakatachalapathy T.S., Mohan Kumar S., Saliba M.J.: A comparative study of burns treated with topical heparin and without heparin. Ann. Burns Fire Disasters, 20: 189-98, 2007.