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

2. 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. 3 Effect of IV Heparin: 30 Day Mortality p =.05 p <.01 Zarychanski et al, CCM 2008;36:2973-9

4. 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 1604- Did not receive therapeutic dose heparin 722 - Received intravenous therapeutic dose heparin 2657 Confirmed cases of Septic Shock 48 703 ICU admissions from 1989-2005 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. 5 Effect of IV Heparin: Hazard Ratios for 30 Day Mortality Zarychanski et al, CCM 2008;36:2973-9

6. 6 Effect of IV heparin and aPC: Hazard Ratios for 30 Day Mortality HeparinaPC Bernard et al, NEJM 2001 Hazard Ratio 1 3-53 30-53 25-29 20-24 3-19 decreased risk increased risk 0.36 0.005 0.02 0.43 P value 4.00.25 APACHE II Quartile Zarychanski et al, CCM 2008;36:2973-9