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Inicio Enfermería Intensiva (English Edition) Ecchymosis and/or haematoma formation after prophylactic administration of subcu...
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Vol. 29. Issue 1.
Pages 4-13 (January - March 2018)
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Vol. 29. Issue 1.
Pages 4-13 (January - March 2018)
Original article
DOI: 10.1016/j.enfie.2017.11.001
Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient
Formación de equimosis y/o hematoma tras la administración profiláctica de enoxaparina subcutánea en abdomen o brazo en pacientes críticos
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R. Jareño-Colladoa, M.M. Sánchez-Sáncheza, M.P. Fraile-Gamoa, N. García-Crespoa, S. Barba-Aragóna, H. Bermejo-Garcíaa, R. Sánchez-Izquierdoa, E.I. Sánchez-Muñoza, A. López-Lópeza, S. Arias-Riverab,
Corresponding author
susana.arias@salud.madrid.org

Corresponding author.
a Servicio de Cuidados Intensivos, Hospital Universitario de Getafe, Getafe, Madrid, Spain
b Hospital Universitario de Getafe, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Getafe, Madrid, Spain
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Table 1. Patient descriptors.
Table 2. The overall incidence of ecchymosis/haematoma and abdomen vs arm at 12, 24, 48 and 72h after the administration of enoxaparin.
Table 3. The overall incidence of ecchymosis/haematoma and abdomen vs arm at 12, 24, 48 and 72h after the administration of enoxaparin.
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Abstract
Introduction

Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site.

Objective

To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient.

Methodology

A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit. Patients receiving prophylactic enoxaparin, admitted >72h, with no liver or haematological disorders, a body mass index (BMI) >18.5, not pregnant, of legal age and with no skin lesions which would impede assessment were included. We excluded patients who died or who were transferred to another hospital before completing the evaluation. We gathered demographic and clinical variables, and the onset of ecchymosis and/or haematomas at the injection site after 12, 24, 48 and 72h. A descriptive analysis was undertaken, with group comparison and logistic regression. The study was approved by the ethics committee with the signed consent of patients/families.

Results

301 cases (11 excluded): 149 were injected in the abdomen vs 141 in the arm. There were no significant differences in demographic and clinical variables, BMI, enoxaparin dose or antiplatelet administration [ecchymosis, abdomen vs arm, n (%): 66 (44) vs 72 (51), P=0.25] [haematoma abdomen vs arm, n (%): 9 (6) vs 14 (10), P=0.2]. Statistical significance was found in the size of the haematomas after 72h: [area of haematoma (mm2) abdomen vs arm, median (IQR): 2 (1–5.25) vs 20(5.25–156), P=0.027].

Conclusions

In our patient cohort, prophylactic subcutaneous enoxaparin administered in the abdomen causes fewer haematomas after 72h, than when administered in the arm. The incidence rate of ecchymosis and haematoma was lower than the published incidence in critically ill patients, although patients receiving anti-platelet agents present a higher risk of injury. No relationship was observed in relation to BMI.

Keywords:
Enoxaparin
Administration
Ecchymosis
Haematoma
Intensive care unit
Resumen
Introducción

Los eventos adversos más frecuentes de la administración subcutánea de heparina de bajo peso molecular son la equimosis y/o el hematoma. No existe una fuerte recomendación sobre la zona de punción.

Objetivo

Evaluar los eventos adversos, equimosis y/o hematoma, tras administración de enoxaparina subcutánea profiláctica en abdomen vs. brazo, en pacientes críticos.

Metodología

Ensayo clínico aleatorizado en dos ramas (inyección abdomen vs. brazo), entre julio de 2014 y enero de 2017, en una unidad de cuidados intensivos polivalente de 18 camas. Incluidos pacientes con enoxaparina profiláctica, ingreso >72h, sin hepatopatías o enfermedades hematológicas, con índice de masa corporal (IMC) >18,5, no embarazadas, mayores de edad y sin lesiones cutáneas que impidan la valoración. Excluidos fallecimientos o traslados de hospital antes de finalizar la valoración. Recogidas variables demográficas, clínicas y aparición de equimosis y/o hematoma en lugar de inyección a las 12, 24, 48 y 72h. Análisis descriptivo, comparación de grupos y regresión logística. Aprobado por la comité de ética, con consentimiento firmado de pacientes/familiares.

Resultados

Un total de 301 casos (11 excluidos): 149 en abdomen vs. 141 en brazo. Sin diferencias significativas en variables demográficas, clínicas, IMC, dosis de enoxaparina y administración de antiagregantes. Equimosis en el 48% de los pacientes y hematoma en el 8%, sin diferencias estadísticas abdomen vs. brazo [equimosis, abdomen vs. brazo, n(%): 66(44) vs. 72(51), p=0,25] [hematoma abdomen vs. brazo, n(%):9(6) vs. 14(10), p=0,2]. Se halla significación estadística en el tamaño del hematoma a las 72h: [área de hematoma (mm2) abdomen vs. brazo, mediana (RIC): 2(1-5,25) vs. 20(5,25-156), p=0,027].

Conclusiones

En nuestra cohorte de pacientes, la enoxaparina subcutánea profiláctica administrada en el abdomen produce menos hematomas, a las 72h, que administrada en el brazo. La tasa de incidencia de equimosis y hematomas es menor a la publicada en pacientes críticos, advirtiéndose que pacientes con antiagregantes presentan mayor riesgo de presentar lesiones, no observándose relación de su aparición con el IMC.

Palabras clave:
Enoxaparina
Administración
Equimosis
Hematoma
Unidad de cuidados intensivos

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