Use of Pharmacologic Prophylaxis Against Venous Thromboembolism in Hospitalized Injured Children

被引:6
作者
Mahajerin, Arash [1 ]
Petty, John K. [2 ]
Hanson, Sheila J. [3 ]
Shabanova, Veronika [4 ]
Faustino, Edward Vincent Suarez [5 ]
机构
[1] CHOC Childrens Hosp, Div Hematol, Orange, CA 92868 USA
[2] Wake Forest Sch Med, Div Pediat Surg, Dept Gen Surg, Winston Salem, NC 27101 USA
[3] Med Coll Wisconsin, Sect Crit Care, Dept Pediat Childrens Wisconsin, Milwaukee, WI 53226 USA
[4] Yale Sch Med, Sect Gen Pediat, Dept Pediat, New Haven, CT USA
[5] Yale Sch Med, Pediat Crit Care Sect, Dept Pediat, New Haven, CT USA
关键词
pediatric trauma; prophylaxis; venous thromboembolism; PEDIATRIC TRAUMA; THROMBOPROPHYLAXIS; THROMBOSIS; CATHETER; OUTCOMES; DESIGN; RISK;
D O I
10.1097/MPH.0000000000002167
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Despite a practice management guideline and risk prediction model for venous thromboembolism (VTE), pediatric-specific evidence on pharmacologic prophylaxis is lacking. In a retrospective study, we characterized receipt of prophylaxis and explored its effectiveness in hospitalized injured patients below 18 years old using data from the Trauma Quality Improvement Program. Concordance of receipt of prophylaxis with guideline and predicted risk of VTE was estimated using kappa statistic. Effectiveness was explored using cohorts matched based on the risk prediction model. A total of 11,165 (6.2%) of 180,932 patients received prophylaxis. Those who received prophylaxis were more commonly post-pubertal and more severely injured. Receipt of prophylaxis was fairly concordant with the guideline (kappa=0.32) and predicted risk of VTE (kappa=0.29). Receipt of prophylaxis was associated with higher rates of VTE likely due to confounding by indication. Low molecular weight heparin seemed more effective against VTE than unfractionated heparin (incidence rate ratio: 0.52; 95% confidence interval: 0.36, 0.75), but less effective when received >= 72 hours after admission to the hospital. We showed that hospitalized injured children did not commonly receive prophylaxis. We also showed that prophylaxis may be effective in hospitalized injured children, but it needs to be proven definitively in a randomized clinical trial.
引用
收藏
页码:E349 / E357
页数:9
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