Low molecular weight heparin associated with better outcomes than unfractionated heparin in pediatric trauma patients

1. Among trauma patients aged 10 to 17, the use of low molecular weight heparin as compared with unfractionated heparin was associated with fewer episodes of venous thromboembolism as well as a reduction in mortality.

Evidence Level Rating: 2 (Good)

Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are the two most common prophylactic agents used to prevent venous thromboembolism (VTE) among trauma patients. Such prophylaxis is standard of care among adults, though its effectiveness and impact on survival is less well-studied among pediatric trauma patients. This retrospective cohort study included 3,934 pediatric trauma patients from the Pediatric American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database who received either LMWH or UFH as pharmacological VTE prophylaxis. The primary outcomes were VTE events, including pulmonary embolism (PE) and deep vein thrombosis (DVT), and mortality. Among patients aged 0 to 9 (n = 477) there was found to be no significant difference in the incidence of DVT (p = 0.47) and PE (p = 0.31) or in the rate of mortality (p = 0.65). However, among patients aged 10 to 14 (n = 730), the incidence of DVT was significantly lower among patients receiving LMWH compared with UFH (1.6% vs. 5.2%, p = 0.02); the rate of mortality was also lower (1.6% vs. 4.8%, p = 0.04). Similar findings were observed among patients aged 15 to 17 (n = 2,599), with the incidence of DVT (1.2% vs. 3.1%, p = 0.03) and rate of mortality (1.2% vs. 2.9%, p = 0.04) lower among those treated with LMWH compared with UFH. Furthermore, among this age group, the incidence of PE was significantly lower (0% vs. 0.6%, p = 0.04). Finally, average hospital length of stay was found to be significantly lower among patients aged 10 to 17 treated with LMWH. These findings suggest that LMWH is a more favorable choice for VTE prophylaxis among pediatric trauma patients aged 10 to 17. Additional, prospective studies should be done to further elucidate this possible benefit.

Click to read the study in the Journal of Pediatric Surgery

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