PMID- 32883505
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20210624
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 56
IP  - 3
DP  - 2021 Mar
TI  - The survival benefit of low molecular weight heparin over unfractionated heparin 
      in pediatric trauma patients.
PG  - 494-499
LID - S0022-3468(20)30525-X [pii]
LID - 10.1016/j.jpedsurg.2020.07.021 [doi]
AB  - 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.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Khurrum, Muhammad
AU  - Khurrum M
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Asmar, Samer
AU  - Asmar S
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Henry, Marion
AU  - Henry M
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Ditillo, Michael
AU  - Ditillo M
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Chehab, Mohamad
AU  - Chehab M
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Tang, Andrew
AU  - Tang A
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Bible, Letitia
AU  - Bible L
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Gries, Lynn
AU  - Gries L
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ.
FAU - Joseph, Bellal
AU  - Joseph B
AD  - Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of 
      Surgery, College of Medicine, University of Arizona, Tucson, AZ. Electronic 
      address: bjoseph@surgery.arizona.edu.
LA  - eng
PT  - Journal Article
DEP - 20200730
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anticoagulants/therapeutic use
MH  - Child
MH  - Heparin
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - *Pediatrics
MH  - *Pulmonary Embolism/epidemiology/prevention & control
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Venous Thromboembolism/epidemiology/etiology/prevention & control
OTO - NOTNLM
OT  - Low molecular weight heparin
OT  - Survival
OT  - TQIP
OT  - Trauma
OT  - Unfractionated heparin
OT  - Venous thromboembolism
COIS- Conflict of interest There are no identifiable conflicts of interests to report
EDAT- 2020/09/05 06:00
MHDA- 2021/06/25 06:00
CRDT- 2020/09/05 06:00
PHST- 2020/04/10 00:00 [received]
PHST- 2020/07/09 00:00 [revised]
PHST- 2020/07/18 00:00 [accepted]
PHST- 2020/09/05 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2020/09/05 06:00 [entrez]
AID - S0022-3468(20)30525-X [pii]
AID - 10.1016/j.jpedsurg.2020.07.021 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2021 Mar;56(3):494-499. doi: 10.1016/j.jpedsurg.2020.07.021. Epub 
      2020 Jul 30.