Effect of early prophylactic heparin use on prognosis in critically ill patients with acute pancreatitis: a retrospective cohort study

Heparin, owing to its anticoagulant and potential anti-inflammatory properties, represents a promising therapeutic option for acute pancreatitis (AP). However, the potential association between heparin use and survival in patients with acute pancreatitis remains uncertain. This study aimed to investigate the association between early heparin administration and clinical outcomes in critically ill AP patients using real-world data. We conducted a retrospective cohort study utilizing the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, which included 852 patients with AP admitted to the intensive care unit (ICU). Propensity score matching (PSM) balanced baseline characteristics, and Cox proportional hazards models evaluated outcomes following prophylactic subcutaneous heparin administration within 24 h of ICU admission. The primary outcome was 28-day all-cause mortality; secondary outcomes included 180-day all-cause mortality, in-hospital all-cause mortality, ICU length of stay, and hospital length of stay. Multivariate Cox regression analysis showed that early prophylactic heparin use was associated with lower 28-day (HR = 0.74, 95% CI 0.57–0.95, P = 0.019), 180-day (HR = 0.72, 95% CI 0.58–0.90, P = 0.004), and in-hospital all-cause mortality (HR = 0.71, 95% CI 0.58–0.88, P = 0.002). These results remained significant after PSM. Subgroup analysis indicated consistent reduction in 28-day all-cause mortality across baseline characteristics (interaction P > 0.05). E-value analysis indicated that the findings were robust to potential unmeasured confounders. In summary, early prophylactic heparin use was associated with lower all-cause mortality in critically ill patients with acute pancreatitis. Future multicenter prospective trials are warranted to validate these findings.