Low-molecular-weight heparin often used in treating young trauma patients despite insufficient scientific evidence
Children and adolescents aged 21 years or younger who are hospitalized for major trauma are often treated with low-molecular-weight heparin (LMWH), an anticoagulant, to prevent blood clots in veins, called venous thromboembolism (VTE). This treatment is routinely recommended for adults with certain major traumas on the basis of scientific evidence. However, there is not similar evidence supporting this treatment’s use in patients under age 21, and there is evidence that the risk of VTE in pediatric trauma patients is much lower than for adults. A new study calls for research to more accurately describe the risks and benefits of this treatment for young trauma patients.
The study is the first to characterize the injuries of young trauma patients given LMWH and clotting-related outcomes (major bleeding or blood clots). The researchers used trauma registry data to describe the number and characteristics of pediatric and adolescent trauma patients treated at two pediatric and two adult trauma centers. Among 706 youngsters treated with LMWH at the four trauma centers during 2007, 38 patients (all but 4 of whom were age 16 or younger) were treated at the pediatric centers and 668 patients (all 14–21 years old) were treated at adult trauma centers. However, the majority of patients receiving LMWH were older (18 to 21 years). Less than 2 percent of patients had chronic illnesses, and the most common injuries for youngsters were lower extremity fractures (50 percent of those in pediatric trauma centers and 34.7 percent of those in adult centers) and head injuries (31.6 percent and 19.8 percent, respectively). A total of 2.1 percent of patients (all at least 15 years old) developed VTE despite LMWH treatment, and approximately half of these patients had a central venous catheter in place. The researchers used data from each center’s trauma registry for 2007–2008. The study was funded by AHRQ (HS17344).
More details are in "Utilization of low-molecular-weight heparin prophylaxis in pediatric and adolescent trauma patients," by Sarah H. O’Brien, M.D., M.Sc., Jennifer Klima, Ph.D., Barbara A. Gaines, M.D., and others in the April–June 2012 Journal of Trauma Nursing 19(2), pp. 117-121.