PMID- 34416415
OWN - NLM
STAT- MEDLINE
DCOM- 20220406
LR  - 20240306
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 268
DP  - 2021 Dec
TI  - Low-Molecular Weight Heparin is Superior to Unfractionated Heparin for Elderly 
      Trauma Patients.
PG  - 432-439
LID - S0022-4804(21)00465-0 [pii]
LID - 10.1016/j.jss.2021.06.074 [doi]
AB  - BACKGROUND: Several studies have demonstrated that low-molecular weight heparin 
      (LMWH) is superior to unfractionated heparin (UFH) in trauma patients. The 
      superiority of either one has not been established for the elderly. In this 
      study, we compared LMWH to UFH in elderly trauma patients. METHODS: A 
      retrospective analysis of the American College of Surgeons' Trauma Quality 
      Improvement Program database was performed for patients aged >/=65 y. Propensity 
      score matching was performed to minimize confounders between the two groups. 
      Outcomes included venous thromboembolic (VTE) and bleeding events. RESULTS: 
      Overall, 93,987 patients were identified (mean age 77.1 +/- 7.3 y, females 55,035 
      [58.6%]), of which 67,738 (72.1%) patients received LMWH and 26,249 (27.9%) 
      received UFH. After Propensity score matching, LMWH was associated with a lower 
      incidence of deep venous thrombosis (1.7% versus 2.1%, P = 0.007) and pulmonary 
      embolisms (0.6% versus 1%, P< 0.001). LMWH was also associated with fewer 
      bleeding complications (transfusions: 2.8% versus 3.5%, P< 0.001, procedures: 
      0.7% versus 0.9%, P = 0.007). Sub-analyses showed that differences in VTE rates 
      were identified in patients with mild injuries (Injury Severity Score [ISS] <16, 
      0.6% versus 1.9%, P< 0.001). Differences in bleeding complications were 
      identified in patients with injuries of mild (ISS <16, transfusions: 3% versus 
      3.8%, P< 0.001, surgeries: 0.3% versus 0.4%, P= 0.015) and moderate severity (ISS 
      16-24, transfusions: 1.9% versus 2.7%, P= 0.038, surgeries: 1% versus 1.7%, P= 
      0.013). CONCLUSION: LMWH prophylaxis is superior to UFH for VTE prevention among 
      elderly trauma patients. LMWH prophylaxis is associated with fewer bleeding 
      complications compared to UFH in patients with injuries of mild or moderate 
      severity.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Gaitanidis, Apostolos
AU  - Gaitanidis A
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Breen, Kerry A
AU  - Breen KA
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Christensen, Mathias A
AU  - Christensen MA
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts; Department of Anesthesia, Center of Head 
      and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, 
      Denmark.
FAU - Saillant, Noelle N
AU  - Saillant NN
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Kaafarani, Haytham M A
AU  - Kaafarani HMA
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Velmahos, George C
AU  - Velmahos GC
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Mendoza, April E
AU  - Mendoza AE
AD  - Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts 
      General Hospital, Boston, Massachusetts. Electronic address: 
      aemendoza@mgh.harvard.edu.
LA  - eng
GR  - R01 HL119248/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20210817
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/adverse effects
MH  - Female
MH  - Heparin/adverse effects
MH  - *Heparin, Low-Molecular-Weight/adverse effects
MH  - Humans
MH  - Molecular Weight
MH  - Retrospective Studies
MH  - *Venous Thromboembolism/epidemiology/etiology/prevention & control
OTO - NOTNLM
OT  - Deep venous thrombosis
OT  - Elderly
OT  - Prophylaxis
OT  - Pulmonary embolism
OT  - Trauma
OT  - Venous thromboembolism
EDAT- 2021/08/21 06:00
MHDA- 2022/04/07 06:00
CRDT- 2021/08/20 20:16
PHST- 2020/09/02 00:00 [received]
PHST- 2021/05/13 00:00 [revised]
PHST- 2021/06/21 00:00 [accepted]
PHST- 2021/08/21 06:00 [pubmed]
PHST- 2022/04/07 06:00 [medline]
PHST- 2021/08/20 20:16 [entrez]
AID - S0022-4804(21)00465-0 [pii]
AID - 10.1016/j.jss.2021.06.074 [doi]
PST - ppublish
SO  - J Surg Res. 2021 Dec;268:432-439. doi: 10.1016/j.jss.2021.06.074. Epub 2021 Aug 
      17.