Abstract
Introduction
Venous thromboembolism (VTE) prophylaxis in pediatric patients is controversial and
is mainly dependent on protocols derived from adult practices. Our study aimed to
compare outcomes among pediatric trauma patients who received low molecular weight
heparin (LMWH) compared to those who received unfractionated heparin (UFH).
Methods
We performed 2 years (2015–2016) retrospective analysis of the Pediatrics ACS-TQIP
database. Pediatric trauma patients (age ≤17) who received thromboprophylaxis with either LMWH or UFH were included. Patients
were stratified into three age groups. Analysis of each subgroup and the entire cohort
was performed. Outcome measures included VTE events (deep vein thrombosis [DVT] and
pulmonary embolism [PE]), hospital and ICU length of stay (LOS) among survivors, and
mortality. Propensity score matching was used to match the two cohorts LMWH vs UFH.
Results
A matched cohort of 1,678 pediatric trauma patients was analyzed. A significant difference
in survival, DVT events, and in-hospital LOS was seen in the age groups above 9 years.
Overall, the patients who received LMWH had lower mortality (1.4% vs 3.6%, p<0.01), DVT (1.7% vs 3.7%, p<0.01), and hospital LOS among survivors (7 days vs 9 days, p<0.01) compared to those who received UFH. There was no significant difference in the
ICU LOS among survivors and the incidence of PE between the two groups.
Conclusion
LMWH is associated with increased survival, lower rates of DVT, and decreased hospital
LOS compared to UFH among pediatric trauma patients age 10–17 years.
Level of Evidence
Level III Prophylactic.
Study Type
Prophylactic.
Key words
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References
- Venous thromboembolism: a public health concern.American journal of preventive medicine. 2010; 38: S495-S501
- Venous thromboembolism in pediatric trauma patients: Ten-year experience and long-term follow-up in a tertiary care center.Pediatric blood & cancer. 2017; 64e26415
- Venous thromboembolism in critically ill children.Current opinion in pediatrics. 2014; 26: 286
- Venous thromboembolism after trauma: when do children become adults?.JAMA surgery. 2013; 148: 1123-1130
- Risk factors for venous thromboembolism in pediatric trauma.Journal of Trauma and Acute Care Surgery. 2002; 52: 922-927
- Venous thromboembolism in children and adolescents.Blood research. 2016; 51: 149-151
- A cross-sectional study evaluating post-thrombotic syndrome in children.Thrombosis research. 2003; 111: 227-233
- Acute prognostic factors for post-thrombotic syndrome in children with limb DVT: a bi-institutional cohort study.Thrombosis research. 2013; 131: 37-41
- Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007.Pediatrics. 2009; 124: 1001-1008
- Preventing deep vein thrombosis in hospital inpatients.Bmj. 2007; 335: 147-151
- Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group.Journal of Trauma and Acute Care Surgery. 2002; 53: 142-164
- Prophylaxis against venous thromboembolism in pediatric trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society.Journal of Trauma and Acute Care Surgery. 2017; 82: 627-636
- Cost and utility of a low-molecular-weight heparin and unfractionated heparin for treatment of deep venous thrombosis in a Balkan country: A model analysis.Experimental & Clinical Cardiology. 2006; 11: 111
- Low-molecular weight heparin for deep vein thrombosis prophylaxis in hospitalized medical patients: results from a cost-effectiveness analysis.Blood coagulation & fibrinolysis. 2007; 18: 309-316
- Parenteral anticoagulants: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2008; 133 (59S): 141S
- Parenteral anticoagulants: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2012; 141: e24S-e43S
- Is laboratory monitoring of low-molecular-weight heparin therapy necessary? No.Journal of Thrombosis and Haemostasis. 2004; 2: 551-554
Carter CJ, Kelton JG, Hirsh J, Cerskus AL, Santos AV, Gent M. The relationship between the hemorrhagic and antithrombotic properties of low molecular weight heparin in rabbits. 1982.
- Effect of low molecular weight fucoidan and low molecular weight heparin in a rabbit model of arterial thrombosis.Journal of vascular research. 2008; 45: 529-537
- Low-molecular-weight fucoidan enhances the proangiogenic phenotype of endothelial progenitor cells.Biochemical Pharmacology. 2005; 70: 1167-1175
- Neuroprotective profile of enoxaparin, a low molecular weight heparin, in in vivo models of cerebral ischemia or traumatic brain injury in rats: a review.CNS drug reviews. 2002; 8: 1-30
- Pharmacological thromboembolic prophylaxis in traumatic brain injuries: low molecular weight heparin is superior to unfractionated heparin.Annals of surgery. 2017; 266: 463-469
- Unfractionated heparin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in trauma.Journal of Trauma and Acute Care Surgery. 2017; 83: 151-158
- Effectiveness of low-molecular-weight heparin versus unfractionated heparin to prevent pulmonary embolism following major trauma: A propensity-matched analysis.Journal of trauma and acute care surgery. 2017; 82: 252-262
- The effect of therapeutic anticoagulation on overall survival in men receiving first-line docetaxel chemotherapy for metastatic castration-resistant prostate cancer.Clinical genitourinary cancer. 2015; 13: 32-38
- A clinical tool for the prediction of venous thromboembolism in pediatric trauma patients.JAMA surgery. 2016; 151: 50-57
- Effect of injury severity on the incidence and utilization-related outcomes of venous thromboembolism in pediatric trauma inpatients.Pediatric critical care medicine. 2009; 10: 554-557
- Venous thromboembolism in the setting of pediatric traumatic brain injury.Journal of Neurosurgery: Pediatrics. 2014; 13: 448-455
- Timing of pharmacologic venous thromboembolism prophylaxis in severe traumatic brain injury: a propensity-matched cohort study.Journal of the American College of Surgeons. 2016; 223: 621-631
- Treatment of low molecular weight heparin inhibits systemic inflammation and prevents endotoxin-induced acute lung injury in rats.Inflammation. 2014; 37: 924-932
- Low-dose low–molecular-weight heparin is anti-inflammatory during venous thrombosis.Journal of vascular surgery. 1998; 28: 848-854
- Anti-inflammatory effects of low molecular weight heparin derivative in a rat model of carrageenan-induced pleurisy.Journal of cellular and molecular medicine. 2009; 13: 2704-2712
- Enoxaparin ameliorates post–traumatic brain injury edema and neurologic recovery, reducing cerebral leukocyte endothelial interactions and vessel permeability in vivo.The journal of trauma and acute care surgery. 2015; 79: 78
- Safety and efficacy of heparin or enoxaparin prophylaxis in blunt trauma patients with a head abbreviated injury severity score >2.Journal of Trauma and Acute Care Surgery. 2011; 71: 396-400
- A randomized, double-blinded, placebo-controlled pilot trial of anticoagulation in low-risk traumatic brain injury: The Delayed Versus Early Enoxaparin Prophylaxis I (DEEP I) study.Journal of Trauma and Acute Care Surgery. 2012; 73: 1434-1441
- Pharmacological and clinical differences between low-molecular-weight heparins: implications for prescribing practice and therapeutic interchange.Pharmacy and Therapeutics. 2010; 35: 95
- Kadziola Z. A comparative, double-blind, randomised trial of a new second generation LMWH (bemiparin) and UFH in the prevention of post-operative venous thromboembolism.Thrombosis and haemostasis. 2000; 83: 523-529
- Retrospective analysis of LMWH and UFH in pediatric trauma patients: a comparative analysis.Journal of Surgical Research. 2020; 249: 121-129
- Thromboprophylaxis for trauma patients.Cochrane Database of Systematic Reviews. 2013; 3
- A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma.New England Journal of Medicine. 1996; 335: 701-707
- Duplex ultrasound screening for deep vein thrombosis in asymptomatic trauma patients: a survey of individual trauma surgeon opinions and current trauma center practices.Journal of Trauma and Acute Care Surgery. 2011; 70: 27-34
Article info
Publication history
Published online: August 31, 2020
Accepted:
July 18,
2020
Received in revised form:
July 9,
2020
Received:
April 10,
2020
Footnotes
☆Presentation: Oral Presentation at the American Surgical Congress; February 2–4, 2020, Orlando, Florida.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
