Low-Molecular-Weight Heparin is Superior for Venous Thromboembolism Prophylaxis in High-Risk Geriatric Trauma Patients

Abstract

INTRODUCTION: Venous thromboembolism (VTE) is a source of preventable morbidity and mortality in trauma patients. Age is one independent risk factor and predictor for the development of VTE. Geriatric patients are a high thromboembolic and hemorrhagic risk. Currently, there is little guidance between low molecular weight heparin (LMWH) and unfractionated heparin (UFH) for VTE prophylaxis in the geriatric trauma patient. METHODS:Retrospective review at an American College of Surgeons Level I Trauma center from 2016 to 2018. Patients 65 years or older with high risk injury (femur or pelvic fracture, spinal cord injury), admitted to the trauma service were included. Choice of agent was at provider discretion. Patients in renal failure, or receiving no chemoprophylaxis, were excluded. The primary outcomes were deep venous thrombosis (DVT) or pulmonary emboism (PE) and hemorrhagic complication (gastrointestinal bleed, traumatic brain injury expansion, hematoma development). RESULTS:This study evaluated 317 subjects, mean Injury Severity Score was 14. 203 (64%) received LMWH and 114 (36%) received UFH. DVT developed in 7.9% of UFH patients, compared with 4% with LMWH (p ¼ 0.19). PE was present in 4.4% of UFH group, but only 0.5% in the LMWH group (p ¼ 0.01). Combined rate of DVT/PE was significantly lower (p ¼ 0.01) in the LMWH (4.4%) group compared with UFH (12.3%) 11 patients had hemorrhagic complication, there was no association between these events and the use of LMWH or UFH.CONCLUSION: VTE events are more common with UFH compared with LMWH. There was a non-significant decrease in hemorrhagic complication when LMWH was used. LMWH should be considered the chemoprophylatic agent of choice in high-risk geriatric trauma patients.

A Challenging Case of Anticoagulation: Acute Traumatic Brain Injury Complicated by Multifocal Venous Thromboembolism

“…Evidence also suggests that UFH and LMWH can reduce cerebral edema and improve neurological recovery by inhibiting the recruitment of leukocytes [29,30] . For the prevention of VTE events, most experts and studies prefer LMWH over UFH, as LMWH has a similar risk of bleeding but a lower incidence of DVT and is associated with reduced mortality [31][32][33][34] .…”