Willians Tambo, MD
Graduate student, PhD Candidate
Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, USFQ, Quito, Ecuador, United States
Disclosure information not submitted.
Andrew Lee, MD
Attending Physician
Long Island Jewish Medical Center, United States
Disclosure information not submitted.
Ivan Sisa, MD, MPH, MS
Attending Physician
Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, USFQ, Quito, Ecuador, United States
Disclosure information not submitted.
Erick Diaz, MD
Attending Physician
Facultad de Ciencias Médicas, de la Salud y la Vida, Escuela de Medicina, Universidad Internacional del Ecuador, UIDE, Quito, Ecuador, United States
Disclosure information not submitted.
Danielle Aronowitz, MD
Resident
Long Island Jewish Medical Center, United States
Disclosure information not submitted.
Fernando Torres, MD
Attending Physician
Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, USFQ, Quito, Ecuador, United States
Disclosure information not submitted.
Rafael Barrera, MD, FCCM, FCCP, FACN
Attending Physician
Long Island Jewish Medical Center, United States
Disclosure information not submitted.
Title: Prophylactic Unfractionated Heparin Does Not Increase Hemorrhage in the Elderly after Neurosurgery
Introduction: To evaluate the effect of age in the development of hemorrhagic complication in surgical intensive care unit (SICU) patients undergoing emergency neurosurgical procedures who received subcutaneous unfractionated heparin (SQUFH) as deep vein thrombosis (DVT) prophylaxis.
Methods: A retrospective analysis was performed on patients admitted to the SICU after emergency neurosurgical procedures. Demographic and clinical related characteristics were collected from patients who received SQUFH as DVT prophylaxis. A χ2 test was used to assess the relationship between age (< 65 vs. >65 years old) and the development of postoperative hemorrhagic complications.
Results: We identified 223 emergency neurosurgical patients: 100 (45%) patients did not receive SQUFH prophylaxis and 123 (55%) patients received SQUFH either within 24 hours of, or 24 hours after admission to the SICU. Among patients who received SQUFH, 73 (59%) were < 65 years old and 50 (41%) were >65 years old. Median APACHE II, APACHE III, and SAPS scores were higher among patients >65 years old compared to patients < 65 years old, regardless of timing of SQUFH administration. Patients >65 years old who received SQUFH within 24 hours of admission had shorter median SICU length of stay than those < 65 years old who received SQUFH within 24 hours of admission (7 days vs 2 days p< 0.001). Postoperative neurologic complications occurred in 34 patients, 85% of whom were < 65 years old (n=29), and 15% were >65 years old (n=5). Postoperative intracranial hemorrhage occurred in one patient who was < 65 years old, and in no patients >65 years old, however this difference did not reach statistical significance (p=1).
Conclusion: Administration of SQUFH in patients undergoing emergency neurosurgical procedures was not associated with increased postoperative hemorrhage in patients >65 years old and could be a safe and effective chemoprophylactic agent against DVT.