Afaf Almabadi^1,, Atheer Almarri¹, Areej Almutairi¹, Mai Alharsan², Shaykhah Almasoud¹, Hanin Al-Harthiy³, Nourah Alzhrani¹, Rana Alsulami¹, Rawdhah alsulami¹, Elaf Alazmi⁴, Ebtsam Abouhashish⁵

Introduction: Subcutaneous heparin administration commonly leads to injection site bruising (Chan, 2001). Previous studies indicate that cold therapy may decrease the size and severity of bruising caused by subcutaneous heparin injections. The primary aim of this study is to evaluate the effectiveness of cold therapy in reducing the size and severity of bruising at the injection site in patients receiving subcutaneous heparin injections. Method: This systematic review examined randomized controlled trials evaluating cold therapy to reduce subcutaneous heparin-induced bruising. The study design involved searching PubMed and Google Scholar databases for relevant keywords (e.g., cold application, cryotherapy, subcutaneous heparin, bruising). Eligible studies enrolled patients who received heparin injections, comparing cold application at the injection site to a control group. The primary outcomes were the incidence and size of injection-site bruising. Exclusion criteria included conditions affecting bruising beyond heparin, interventions beyond cold therapy, a lack of a control group, and failure to assess both bruising incidence and extent. Results: Based on the search criteria, 374 patients were found. We reviewed 581 patients for this systematic review from 10 full-text articles. The results from the six articles indicated a substantial decrease in the severity of bruising, with the experimental group performing better than the control group. However, there was considerable variation across the different studies. Individual research data varied substantially in terms of average bruise intensity. Conclusion: The results indicate that cold application effectively reduces the severity of bruising in patients receiving subcutaneous heparin injections. However, significant heterogeneity is observed across studies, attributable to differences in the language of publication, cold application interventions, and injection methods (e.g., site and needle size). Increased standardization of the cold therapy protocol and injection techniques in future research would help minimize these sources of variability and enable more robust comparative analysis.

Cold application, cryotherapy, ice, subcutaneous heparin, injection, bruising, ecchymosis, or hematoma