title: The safety and efficacy of use of low-molecular-weight heparin in pediatric neurosurgical patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: David D
authors.initials: DD
authors.lastname: Gonda
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Jared
authors.initials: J
authors.lastname: Fridley
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Ryan
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Valentina
authors.initials: V
authors.lastname: Briceño
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sandi K
authors.initials: SK
authors.lastname: Lam
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Luerssen
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015951:Factor Xa / Q000378:metabolism; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007279:Injections, Subcutaneous; D008297:Male; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006495:Heparin, Low-Molecular-Weight; D015951:Factor Xa
keywords: LMWH = low-molecular-weight heparin; VTE = venous thromboembolic event; anticoagulation; deep venous thrombosis; enoxaparin; hemorrhage; low-molecular-weight heparin; pediatric neurosurgery; vascular disorders; venous thromboembolism