Related Experiment Video
Updated: Jul 19, 2025
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thromboprophylaxis in pediatric patients with earthquake-related crush syndrome: a single centre experience
Feryal Karahan1, Selma Ünal1, Özlem Tezol2
1Faculty of Medicine, Department of Pediatric Hematology, Mersin University, Mersin, Turkey.
Insights
Pediatric patients with crush injuries from earthquakes received anticoagulant therapy to prevent venous thromboembolism (VTE). This approach resulted in a low VTE rate of 2.1% in this high-risk group.
Area of Science:
- Pediatric Critical Care Medicine
- Trauma Surgery
- Hematology
Background:
- Crush injuries significantly elevate the risk of venous thromboembolism (VTE).
- Limited data exists on managing anticoagulant therapy for VTE prophylaxis in pediatric patients with crush injuries, particularly those from mass casualty events.
- Earthquake-related crush syndrome presents unique challenges for VTE risk assessment and management in children.
Purpose of the Study:
- To share clinical experience in managing anticoagulant thromboprophylaxis for pediatric patients with earthquake-related crush syndrome.
- To evaluate the effectiveness of an adapted VTE prevention guideline in this specific pediatric trauma population.
- To determine the VTE rate in pediatric crush injury patients following a standardized thromboprophylaxis protocol.
Main Methods:
- A cohort of pediatric patients with earthquake-related crush syndrome was assessed for VTE risk.
- VTE risk stratification was performed by adapting guidelines for perioperative VTE prevention in adolescents due to the absence of pediatric trauma-specific VTE guidelines.
- Anticoagulant thromboprophylaxis with enoxaparin was administered based on VTE risk level (low, moderate, high) and age.
Main Results:
- Forty-nine pediatric patients with earthquake-related crush syndrome were included.
- VTE risk was stratified: 14.6% low risk, 27.1% moderate risk, and 58.3% high risk.
- Prophylactic enoxaparin was given to moderate-risk patients and high-risk patients under 13 years unable to mobilize early, and to all high-risk patients aged 13 years and older.
Conclusions:
- The implemented decision-making algorithm for thromboprophylaxis in pediatric crush syndrome patients was associated with a low VTE rate of 2.1%.
- Adapting existing VTE guidelines for perioperative adolescent patients proved effective for risk assessment and prophylaxis in earthquake-related crush injuries.
- This study highlights the importance of proactive VTE prophylaxis in pediatric trauma patients, even in resource-limited disaster settings.
Purpose:
Injuries increase the risk of venous thromboembolism (VTE). However, the literature on the management of anticoagulant therapy in pediatric patients with crush injury is limited. In this study, we aimed to share our experience about anticoagulant thromboprophylaxis in pediatric patients with earthquake-related crush syndrome.
Methods:
This study included patients who were evaluated for VTE risk after the Turkey-Syria earthquake in 2023. Since there is no specific pediatric guideline for the prevention of VTE in trauma patients, risk assessment for VTE and decision for thromboprophylaxis was made by adapting the guideline for the prevention of perioperative VTE in adolescent patients.
Results:
Forty-nine patients [25 males and 24 females] with earthquake-related crush syndrome had participated in the study. The median age of the patients was 13.5 (8.8-15.5) years. Seven patients (14.6%) who had no risk factors for thrombosis were considered to be at low risk and did not receive thromboprophylaxis. Thirteen patients (27.1%) with one risk factor for thrombosis were considered to be at moderate risk and 28 patients (58.3%) with two or more risk factors for thrombosis were considered to be at high risk. Moderate-risk patients (n = 8) and high-risk patients aged < 13 years (n = 11) received prophylactic enoxaparin if they could not be mobilized early, while all high-risk patients aged ≥ 13 years (n = 13) received prophylactic enoxaparin.
Conclusion:
With the decision-making algorithm for thyromboprophylaxis we used, we observed a VTE rate of 2.1% in pediatric patients with earthquake-related crush syndrome.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:27Pulmonary Embolism III: Nursing Management
01:30Venous Thrombosis IV: Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...