1 Heparin-associated 30 Day Mortality Zarychanski et al, CCM 2008;36:2973-9

2 Heparin-Associated 30 Day Mortality Adjusted Cox Proportional hazards of mortality with therapeutic dose IV heparin Zarychanski et al, CCM 2008;36:2973-9

3 Effect of IV Heparin: 30 Day Mortality p =.05 p <.01 Zarychanski et al, CCM 2008;36:2973-9

4 Level 2 Exclusion: (n = 331) 157 Patients died within 48 hours of admission 174 Patients who received heparin >48 hour after admission 2326 – Final study cohort Did not receive therapeutic dose heparin Received intravenous therapeutic dose heparin 2657 Confirmed cases of Septic Shock ICU admissions from Level 1 Exclusion: (n = 255 ) 112 Mixed shock states with clinically significant cardiogenic, hemorrhagic, or obstructive elements 143 Definitive admitting diagnosis of ACS, MI or pulmonary embolus 2912 Identified cases of Septic Shock Inclusion Criteria: Meet 1991 SCCM/ACCP Criteria for septic shock Effect of IV Heparin: 30 Day Mortality Zarychanski et al, CCM 2008;36:2973-9

5 Effect of IV Heparin: Hazard Ratios for 30 Day Mortality Zarychanski et al, CCM 2008;36:2973-9

6 Effect of IV heparin and aPC: Hazard Ratios for 30 Day Mortality HeparinaPC Bernard et al, NEJM 2001 Hazard Ratio decreased risk increased risk P value APACHE II Quartile Zarychanski et al, CCM 2008;36:2973-9