The safety and efficacy of use of low-molecular-weight heparin in pediatric neurosurgical patients

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Low-molecular-weight heparins (LMWHs), mainly enoxaparin, offer several advantages over standard anticoagulation therapies such as unfractionated heparin and warfarin, including predictable pharmacokinetics, minimal monitoring, and subcutaneous administration. The purpose of this study was to determine the safety and efficacy of LMWHs in pediatric neurosurgical patients.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective study was performed with patients 18 years old or younger who were admitted to the Pediatric Neurosurgery Service at Texas Children's Hospital and treated with LMWH for either therapeutic or prophylactic purposes between March 1, 2011, and December 30, 2013. Demographic and clinical features and outcomes were recorded.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>LMWH was administered for treatment of venous thromboembolic events (VTEs) in 17 children and for prophylaxis in 24 children. Clinical resolution of VTEs occurred in 100% (17 of 17) of patients receiving therapeutic doses of LMWH. No patient receiving prophylactic doses of LMWH developed a new VTE. Major or minor bleeding complications occurred in 18% (3 of 17 children) and 4% (1 of 24 children) of those receiving therapeutic and prophylactic doses, respectively. All 4 patients who experienced hemorrhagic complications had other bleeding risk factors—i.e., coagulopathies and antiplatelet medications.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>LMWH seems to be safe and efficacious for both management and prophylaxis of VTEs in pediatric neurosurgery. However, pediatric practitioners should be aware of higher risk for bleeding complications with increasing doses of LMWH, especially in patients with preexisting bleeding disorders or concurrent use of antiplatelet agents.</jats:p></jats:sec>

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

“…Several studies support the usage in the neurosurgical population as well [21][22][23][24]. The belief that pharmacologic VTE prophylaxis should be withheld in any patient at increased risk for bleeding is largely unsupported by literature, it is yet a practice widely performed.…”

Population Pharmacokinetics of Enoxaparin in Pediatric Patients

“…Enoxaparin is a low-molecular-weight heparin commonly used for the treatment and prophylaxis of thromboembolism in pediatric patients. [1][2][3][4][5][6][7][8][9][10][11] Despite widespread use, pharmacokinetic data to give dosing guidance in pediatrics is sparse. The dosing of enoxaparin in pediatrics has been extrapolated from adult data and subsequently refined through clinical experience.…”

Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis

“…After excluding duplicate studies and articles not directly related to our hypothesis, a total of 32 articles re-mained. Of these, 20 were excluded for being retrospective or not related to the study question, 3 articles 11,34 were pediatric reports, and 4 articles 2,10,21,22 did not have a controlled placebo group. This left a total of 5 articles 1,5,13,25 for inclusion.…”