title: Reliable low-molecular-weight heparin reversal in a child undergoing emergency surgery: a case report.
abstract: Low-molecular-weight heparin neutralization using protamine alone can be unreliable, especially in cases of immediate reversal for emergency surgery. Here, we describe a unique case of a 17-month-old girl with a history of glioneuronal tumor and corresponding hydrocephalus status post debulking and ventriculoperitoneal shunt placement, who was placed on enoxaparin after the development of a sagittal sinus thrombosis. Patient presented for emergency craniectomy and evacuation of subdural bleed after a fall while on therapeutic dose of enoxaparin. Protamine and fresh frozen plasma were used in the patient's perioperative course providing a reliable reversal of enoxaparin.
authors.affiliation: University of Toledo College of Medicine, Toledo, OH, USA.
authors.forename: Mena M
authors.initials: MM
authors.lastname: Botros
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mahmoud
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA. Electronic address: acostandi@chla.usc.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Costandi
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery; D056424:Decompressive Craniectomy / Q000379:methods*; D004632:Emergency Medical Services; D017984:Enoxaparin / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D005260:Female; D006494:Heparin Antagonists / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D017287:Ventriculoperitoneal Shunt
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006494:Heparin Antagonists; D006495:Heparin, Low-Molecular-Weight
keywords: Enoxaparin; Fresh frozen plasma; LMWH(s); Low molecular weight heparin; Protamine sulfate