Improving Survival In Pediatrics Patients With Severe Traumatic Brain Injury: A Novel Therapy
Alexandra Barbosa, Kamil Hanna, Mohammad Hamidi, Marion Henry, Narong Kulvatunyou, Michael Ditillo, Muhammad Zeeshan, Bellal Joseph
University of Arizona, Tucson, AZ
Background:Experimental work has demonstrated the neuroprotective effect of low molecular weight heparin (LMWH) in cerebral ischemic animal models. Thromboprophylaxis with LMWH or unfractionated heparin (UFH) is recommended to prevent thromboembolic complications. The aim of our study was to evaluate the outcomes in pediatric TBI patients who received LMWH compared to UFH.
Methods:We performed a 3-year analysis of the Pediatrics ACS-TQIP and included pediatric patients with blunt isolated-severe TBI (head-AIS≥3 & extracranial-AIS<3) who received pharmacological thromboprophylaxis. Patients were stratified: LMWH vs. UFH. Primary outcomes were VTE complications (DVT and PE) and mortality. Secondary outcomes were unplanned return to the operating room (OR). Multivariate regression analysis was performed.
Findings:We reviewed 980 patients, of which 44.5%(436) received LMWH and 55.5%(544) UFH. Mean age was 12±6y, and the median head-AIS was 4[3-5]. Overall mortality was 3.1%, DVT rate was 3.8%, and none of the patients had a PE. Patients in the LMWH group had lower mortality (0.7% vs. 5%,P=0.02) and DVT (1.5 % vs. 3.7%,P=0.03). However, there was no difference in the rate of unplanned return to OR (1.4% vs. 1.7%,P=0.83). On regression analysis, LMWH was independently associated with improved survival (OR: 1.40[1.19-1.86]) and lower odds of DVT (OR: 0.77[0.52-0.93]). LMWH was not associated with unplanned return to OR (OR: 0.54 [0.6-4.2],p=0.54).
Conclusions:LMWH prophylaxis in severe TBI is associated with better survival and lower rates of DVT. The use of LMWH warrants serious consideration. Further studies are required to explore the mechanism by which LMWH improves survival.
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