Retrospective Analysis of LMWH and UFH in Pediatric Trauma Patients: A Comparative Analysis

Michael Hunter Culbert, Mohammad Hamidi, Muhammad Zeeshan, Kamil Hanna, Andrew Romero, Bellal Joseph, Terence O'Keeffe

Research output: Contribution to journalArticle

Abstract

Background: Chemoprophylaxis with either unfractionated heparin (UFH) or Low-Molecular-Weight Heparin (LMWH) are recommended to prevent Venous Thromboembolism (VTE) after trauma. Experimental work has shown beneficial effects of LMWH in animal models, but it is unknown if similar effects exist in humans. We hypothesized that treatment with LMWH is associated with a survival benefit when compared to UFH. Methods: We performed a retrospective analysis of our level I trauma center database from January 2009 to June 2018. Pediatric patients (age < 18) were included if they received either LMWH or UFH during their stay. Outcome measures included mortality, VTE complications, and hospital length of stay (HLOS). Results: A total of 354 patients were included. Patients who received LMWH had lower mortality compared to those who received UFH. After multivariate logistic regression, LMWH was still independently associated with improved survival. No association was found between LMWH and UFH regarding deep vein thrombosis (DVT) or pulmonary embolism (PE) rates. No association was found between LMWH with HLOS. Conclusions: LMWH was associated with improved survival compared to UFH in our pediatric trauma patients. This was independent of injury severity or VTE complications. Further studies are required to understand better the mechanisms by which LMWH improves survival. Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)121-129
Number of pages9
JournalJournal of Surgical Research
Volume249
DOIs
StatePublished - May 2020

Fingerprint

Low Molecular Weight Heparin
Heparin
Pediatrics
Wounds and Injuries
Length of Stay
Venous Thromboembolism
Survival
Mortality
Trauma Centers
Chemoprevention
Pulmonary Embolism
Venous Thrombosis
Animal Models
Logistic Models
Outcome Assessment (Health Care)
Databases

Keywords

  • Low molecular weight heparin
  • Mortality
  • Pediatrics
  • Trauma
  • VTE prophylaxis

ASJC Scopus subject areas

  • Surgery

Cite this

Retrospective Analysis of LMWH and UFH in Pediatric Trauma Patients : A Comparative Analysis. / Culbert, Michael Hunter; Hamidi, Mohammad; Zeeshan, Muhammad; Hanna, Kamil; Romero, Andrew; Joseph, Bellal; O'Keeffe, Terence.

In: Journal of Surgical Research, Vol. 249, 05.2020, p. 121-129.

Research output: Contribution to journalArticle

Culbert, Michael Hunter ; Hamidi, Mohammad ; Zeeshan, Muhammad ; Hanna, Kamil ; Romero, Andrew ; Joseph, Bellal ; O'Keeffe, Terence. / Retrospective Analysis of LMWH and UFH in Pediatric Trauma Patients : A Comparative Analysis. In: Journal of Surgical Research. 2020 ; Vol. 249. pp. 121-129.
@article{84b710b7ae14475eb74181c692cbd260,
title = "Retrospective Analysis of LMWH and UFH in Pediatric Trauma Patients: A Comparative Analysis",
abstract = "Background: Chemoprophylaxis with either unfractionated heparin (UFH) or Low-Molecular-Weight Heparin (LMWH) are recommended to prevent Venous Thromboembolism (VTE) after trauma. Experimental work has shown beneficial effects of LMWH in animal models, but it is unknown if similar effects exist in humans. We hypothesized that treatment with LMWH is associated with a survival benefit when compared to UFH. Methods: We performed a retrospective analysis of our level I trauma center database from January 2009 to June 2018. Pediatric patients (age < 18) were included if they received either LMWH or UFH during their stay. Outcome measures included mortality, VTE complications, and hospital length of stay (HLOS). Results: A total of 354 patients were included. Patients who received LMWH had lower mortality compared to those who received UFH. After multivariate logistic regression, LMWH was still independently associated with improved survival. No association was found between LMWH and UFH regarding deep vein thrombosis (DVT) or pulmonary embolism (PE) rates. No association was found between LMWH with HLOS. Conclusions: LMWH was associated with improved survival compared to UFH in our pediatric trauma patients. This was independent of injury severity or VTE complications. Further studies are required to understand better the mechanisms by which LMWH improves survival. Level of Evidence: 3.",
keywords = "Low molecular weight heparin, Mortality, Pediatrics, Trauma, VTE prophylaxis",
author = "Culbert, {Michael Hunter} and Mohammad Hamidi and Muhammad Zeeshan and Kamil Hanna and Andrew Romero and Bellal Joseph and Terence O'Keeffe",
year = "2020",
month = "5",
doi = "10.1016/j.jss.2019.11.019",
language = "English (US)",
volume = "249",
pages = "121--129",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Retrospective Analysis of LMWH and UFH in Pediatric Trauma Patients

T2 - A Comparative Analysis

AU - Culbert, Michael Hunter

AU - Hamidi, Mohammad

AU - Zeeshan, Muhammad

AU - Hanna, Kamil

AU - Romero, Andrew

AU - Joseph, Bellal

AU - O'Keeffe, Terence

PY - 2020/5

Y1 - 2020/5

N2 - Background: Chemoprophylaxis with either unfractionated heparin (UFH) or Low-Molecular-Weight Heparin (LMWH) are recommended to prevent Venous Thromboembolism (VTE) after trauma. Experimental work has shown beneficial effects of LMWH in animal models, but it is unknown if similar effects exist in humans. We hypothesized that treatment with LMWH is associated with a survival benefit when compared to UFH. Methods: We performed a retrospective analysis of our level I trauma center database from January 2009 to June 2018. Pediatric patients (age < 18) were included if they received either LMWH or UFH during their stay. Outcome measures included mortality, VTE complications, and hospital length of stay (HLOS). Results: A total of 354 patients were included. Patients who received LMWH had lower mortality compared to those who received UFH. After multivariate logistic regression, LMWH was still independently associated with improved survival. No association was found between LMWH and UFH regarding deep vein thrombosis (DVT) or pulmonary embolism (PE) rates. No association was found between LMWH with HLOS. Conclusions: LMWH was associated with improved survival compared to UFH in our pediatric trauma patients. This was independent of injury severity or VTE complications. Further studies are required to understand better the mechanisms by which LMWH improves survival. Level of Evidence: 3.

AB - Background: Chemoprophylaxis with either unfractionated heparin (UFH) or Low-Molecular-Weight Heparin (LMWH) are recommended to prevent Venous Thromboembolism (VTE) after trauma. Experimental work has shown beneficial effects of LMWH in animal models, but it is unknown if similar effects exist in humans. We hypothesized that treatment with LMWH is associated with a survival benefit when compared to UFH. Methods: We performed a retrospective analysis of our level I trauma center database from January 2009 to June 2018. Pediatric patients (age < 18) were included if they received either LMWH or UFH during their stay. Outcome measures included mortality, VTE complications, and hospital length of stay (HLOS). Results: A total of 354 patients were included. Patients who received LMWH had lower mortality compared to those who received UFH. After multivariate logistic regression, LMWH was still independently associated with improved survival. No association was found between LMWH and UFH regarding deep vein thrombosis (DVT) or pulmonary embolism (PE) rates. No association was found between LMWH with HLOS. Conclusions: LMWH was associated with improved survival compared to UFH in our pediatric trauma patients. This was independent of injury severity or VTE complications. Further studies are required to understand better the mechanisms by which LMWH improves survival. Level of Evidence: 3.

KW - Low molecular weight heparin

KW - Mortality

KW - Pediatrics

KW - Trauma

KW - VTE prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=85077651273&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077651273&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2019.11.019

DO - 10.1016/j.jss.2019.11.019

M3 - Article

AN - SCOPUS:85077651273

VL - 249

SP - 121

EP - 129

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

ER -