Reliable low-molecular-weight heparin reversal in a child undergoing emergency surgery: a case report

J Clin Anesth. 2016 Sep:33:317-9. doi: 10.1016/j.jclinane.2016.04.036. Epub 2016 May 18.

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.

Keywords: Enoxaparin; Fresh frozen plasma; LMWH(s); Low molecular weight heparin; Protamine sulfate.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants / therapeutic use
  • Blood Loss, Surgical
  • Brain Neoplasms / complications
  • Brain Neoplasms / surgery
  • Decompressive Craniectomy / methods*
  • Emergency Medical Services
  • Enoxaparin / antagonists & inhibitors*
  • Enoxaparin / therapeutic use
  • Female
  • Heparin Antagonists / therapeutic use*
  • Heparin, Low-Molecular-Weight / antagonists & inhibitors*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Infant
  • Ventriculoperitoneal Shunt

Substances

  • Anticoagulants
  • Enoxaparin
  • Heparin Antagonists
  • Heparin, Low-Molecular-Weight