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Safe Use of Low-Molecular-weight Heparin in Pediatric Acute Lymphoblastic Leukemia and Lymphoma Around Lumbar

Jeremie H Estepp1, Matthew P Smeltzer, Guolian Kang

  • 1*Department of Hematology †Department of Pathology §Department of Biostatistics, St. Jude Children's Research Hospital ‡Division of Epidemiology, Biostatistics, and Environmental Health, The University of Memphis School of Public Health ¶University of Tennessee Health Science Center, Memphis, Memphis, TN.

Journal of Pediatric Hematology/Oncology
|October 10, 2017
PubMed

Insights

Withholding low-molecular-weight heparin (LMWH) for 24 hours before and after lumbar punctures (LPs) is safe for children with acute lymphoblastic leukemia (ALL). This practice did not increase bleeding complications in pediatric ALL patients undergoing LPs.

Area of Science:

  • Pediatric Hematology Oncology
  • Pharmacology
  • Neurology

Background:

  • Children with acute lymphoblastic leukemia (ALL) or lymphoma often require low-molecular-weight heparin (LMWH) for thromboembolic issues.
  • These patients also undergo frequent lumbar punctures (LPs) for diagnosis and treatment.

Purpose of the Study:

  • To evaluate the safety of withholding LMWH for 24 hours before and after LPs in pediatric ALL patients.
  • To determine if this practice prevents bleeding complications such as spinal hematomas.

Main Methods:

  • Retrospective analysis of 133 pediatric ALL patients treated between 2004 and 2012.
  • Examined 1708 LPs performed while patients were on LMWH therapy.
  • Defined spinal hematoma and traumatic LP based on clinical suspicion, imaging, and cerebrospinal fluid analysis.

Main Results:

  • No spinal hematomas were observed in any of the 1708 LPs.
  • The probability of spinal hematoma per LP was 0% (95% CI, 0.0%-0.2%).
  • Traumatic LPs were more frequent when LMWH was not administered (OR, 1.5; 95% CI, 1.1-2.2).

Conclusions:

  • Withholding LMWH for 24 hours before and after LPs is a safe strategy for pediatric ALL patients.
  • This approach does not appear to increase the risk of spinal hematomas.
  • The findings support current clinical practice guidelines for managing LMWH in pediatric ALL patients undergoing LPs.

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