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Yoon-Hee Cha, John H. Chi, and Nicholas M. Barbaro

puncture. Low-molecular-weight heparin therapy has become favored in the treatment of venous thromboembolisms and acute cardiac ischemia because of its predictable anticoagulant response, longer half-life, and its lack of blood monitoring requirements. 10 To date, there are no known cases of spinal spontaneous SDHs occurring in patients undergoing LMWH therapy when spinal instrumentation is not also being used. 9, 11 We present the case of a patient in whom an acute spinal spontaneous SDH developed while she was receiving LMWH and discuss possible contributing factors

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Inge A. van Erp, Apostolos Gaitanidis, Mohamad El Moheb, Haytham M. A. Kaafarani, Noelle Saillant, Ann-Christine Duhaime, and April E. Mendoza

either low-molecular-weight heparin (LMWH) or unfractionated heparin (UH). 10 The Eastern Association for the Surgery of Trauma recommends using LMWH over UH in children older than 15 years of age with an ISS greater than 25. 8 However, this recommendation largely reflects current clinical practice, as there is a paucity of evidence supporting the use of either in pediatric patients. Because of its shorter half-life and ease of reversal, UH is preferred over LMWH by many clinicians, especially in high-risk TBI patients. 10 However, recent experimental studies have

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David D. Gonda, Jared Fridley, Sheila L. Ryan, Valentina Briceño, Sandi K. Lam, MD MBA, Thomas G. Luerssen, and Andrew Jea

inpatient costs and length of stay in young trauma patients. 4 , 8 Current therapy for management of VTEs in children is extrapolated from clinical experience and trials with adult patients. It usually consists of therapy with unfractionated heparin, low-molecular-weight heparin (LMWH), oral anticoagulants, or a combination of these medications. 1 , 10 Poor venous access, unpredictable pharmacokinetics requiring serial monitoring, increased risk of bleeding related to primary disorders, and the influence of disease, diet, or medications adversely influence the safe

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Spontaneous spinal hematomas and low-molecular-weight heparin

Report of four cases and review of the literature

Peter A. Heppner, Stephen J. Monteith, and Andrew J. J. Law

in causing spinal hematomas. 4, 8, 18, 22 There has been substantial documentation in the literature on the association between neuraxis anesthesia, low-molecular-weight heparin, and spinal hematomas. Spinal hematomas arising in the absence of trauma or epidural anesthesia have been rarely reported. Our goal in this article is to raise awareness of the possibility of spontaneous spinal hematomas arising secondary to low-molecular-weight heparin use. Additionally, we reviewed the literature to determine the presence of other risk factors predisposing to this

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Anthony M. DiGiorgio, Rachel Tsolinas, Mohanad Alazzeh, Jenny Haefeli, Jason F. Talbott, Adam R. Ferguson, Jacqueline C. Bresnahan, Michael S. Beattie, Geoffrey T. Manley, William D. Whetstone, Praveen V. Mummaneni, and Sanjay S. Dhall

Spine and Peripheral Nerves. These guidelines give a Class I recommendation for low-molecular-weight heparin (LMWH) use for VTE prophylaxis and a Class II recommendation for starting within 72 hours of injury. 3 Transforming Research and Clinical Knowledge in SCIs (TRACK SCI) is a prospective observational study based at the University of California, San Francisco. It introduced a standardized SCI treatment protocol and prospective data collection. The trauma protocol includes administration of LMWH (enoxaparin) within 24 hours of injury. The aim of the present study

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Samuel R. Browd, Brian T. Ragel, Gary E. Davis, Amy M. Scott, Elaine J. Skalabrin, and William T. Couldwell

The incidence of deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) in patients undergoing neurosurgery has been reported to be as high as 25%, with a mortality rate from PE between 9 and 50%. Even with the use of pneumatic compression devices, the incidence of DVT has been reported to be 32% in these patients, making prophylactic heparin therapy desirable. Both unfractionated and low-molecular-weight heparin have been shown to reduce the incidence of DVT consistently by 40 to 50% in neurosurgical patients. The baseline rate for major intracranial hemorrhage (ICH) following craniotomy has been reported to be between 1 and 3.9%, but after initiation of heparin therapy this rate has been found to be as high as 10.9%. Therefore, neurosurgeons must balance the risk of PE against the increased risk of postoperative ICH from prophylactic heparin for DVT. The authors review the literature on the incidence of DVT and PE in neurosurgical patients, focusing on the incidence of ICH related to the use of unfractionated and low-molecular-weight heparin in this patient population

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Kiyoyuki Yanaka, Stephen R. Spellman, James B. McCarthy, Theodore R. Oegema Jr., Walter C. Low, and Paul J. Camarata

. Materials and Methods Experimental Protocol Sixty male Sprague—Dawley rats weighing between 270 and 350 g were used in this study. The experiment was approved by the Animal Care Committee at the University of Minnesota and conducted under the auspices of Research Animal Resources, a facility approved by the American Association for the Accreditation of Laboratory Animal Care. The animals were allocated to one of seven groups: transient cerebral ischemia without treatment (Group I); treatment with intravenous administration of low-molecular-weight heparin (total 4 mg

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Jari Siironen, Seppo Juvela, Joona Varis, Matti Porras, Kristiina Poussa, Sorella Ilveskero, Juha Hernesniemi, and Riitta Lassila

well as other low-molecular-weight heparins, can be used safely and efficiently for the prevention of venous thromboembolism after neurosurgical procedures, 1, 24 the majority of which in these previous studies, however, have been for brain tumor or spinal disorders. On the basis of its well-established effects as a preventive agent for blood coagulation, enoxaparin may have a beneficial effect on brain circulation, on acute and delayed ischemia, and thus also on final outcome after SAH. The aim of this study, therefore, was to investigate enoxaparin's effect on

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Florian Gessler, Markus Bruder, Stephan Duetzmann, Stephanie Tritt, Joshua D. Bernstock, Volker Seifert, and Christian Senft

demographics, tumor pathology, histological grading, patient position during surgery, location of the tumor, proximity to a major sinus, sinus compression and/or infiltration, location of craniotomy, duration of surgery, known CVT risk factors (as described below), intraoperative sinus or sinus vein injury, initial clinical manifestations of CVT occurrence, neurological outcome, complications, number of affected sinus vein segments, degree of recanalization at last follow-up, time to diagnosis after surgery, time to intermediate-dose low-molecular-weight heparin (LMWH

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Risheng Xu, Mohamad Bydon, Ziya L. Gokaslan, Jean-Paul Wolinsky, Timothy F. Witham, and Ali Bydon

-Pierre A , : Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus . N Engl J Med 336 : 1634 – 1640 , 1997 12 Cassidy JD , Carroll LJ , Cote P : The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults . Spine 23 : 1860 – 1867 , 1998 13 Cosmi B , Hirsh J : Low molecular weight heparins . Curr Opin Cardiol 9 : 612 – 618 , 1994 14 Cote P , Cassidy JD , Carroll L : The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain