What is the role of heparin and pentoxifylline in the treatment of smoke inhalation injuries?

Updated: Oct 15, 2021
  • Author: Keith A Lafferty, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Since the pathophysiology of smoke inhalation involves irritants setting off the inflammatory response, many recent studies have investigated the benefit of anti-inflammatories and anticoagulants as treatment options for this underlying pathogenesis of injury. Treatment with heparin and pentoxifylline has been shown to improve lung function after smoke inhalation.

Aside from its known effect on thrombin, heparin has been recognized to have a protective effect on microvascular endothelium. Its anionic sulfate groups give the compound the ability to function as a cation exchanger, thereby limiting the endothelial permeability of cationic proteases released by polymorphonuclear leukocytes (PMLs). Pentoxifylline has not only been observed to improve microvascular circulation, but also suggested to play a role in down-regulating the production and release of inflammatory mediators.

Currently, both heparin and pentoxifylline are delivered systemically, but with limited success in penetrating the deep lung areas. However, a feasible delivery alternative allowing deeper penetration and a rapid local onset of action for the acceleration of healing may provide clinical benefits in the future.

A study of inhalable aerosol formulations of heparin and pentoxifylline in particles 5 µm or smaller demonstrated that co-spraying of heparin or pentoxifylline with leucine supplementation over a 24-hour period allowed for deep lung drug deposition and a possible efficient route to improve therapeutic outcomes for smoke inhalation. [7]

In contrast, a systematic review of heparin use in burn injury (topically, subcutaneously, intravenously, or via aerosol) found no strong evidence that heparin can improve clinical outcomes. Oremus and colleagues suggested that poor methodologic quality in studies of heparin may have led to severe bias in reports of its benefit. [52]

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