Related Experiment Video
Updated: Oct 5, 2026
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Prophylactic therapy with enoxaparin during L-asparaginase treatment in children with acute lymphoblastic leukemia
1Department of Pediatric Hemato-Oncology, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Insights
Low molecular weight heparin (LMWH) enoxaparin prophylaxis effectively prevented thromboembolism in children with acute lymphoblastic leukemia (ALL) during L-asparaginase treatment, with no bleeding events observed.
Area of Science:
- Hematology
- Pediatric Oncology
- Pharmacology
Background:
- L-asparaginase treatment for acute lymphoblastic leukemia (ALL) is associated with an increased risk of thromboembolism.
- Thrombophilic polymorphisms may further elevate this risk in pediatric ALL patients.
Purpose of the Study:
- To evaluate the safety and efficacy of enoxaparin prophylaxis in preventing thromboembolic events in children with ALL undergoing L-asparaginase therapy.
- To assess bleeding episodes and identify thrombophilic risk factors in this patient population.
Main Methods:
- A prospective study involving 41 children with ALL receiving enoxaparin prophylaxis during L-asparaginase treatment.
- Molecular analysis for common thrombophilic polymorphisms (prothrombin G20210A, MTHFR C677T, factor V Leiden).
- Comparison with a historical control group of 50 ALL children not receiving enoxaparin prophylaxis.
Main Results:
- No thromboembolic events occurred in 41 patients receiving enoxaparin prophylaxis across 76 treatment courses.
- One patient experienced a brain infarct 7 days after enoxaparin discontinuation.
- No bleeding episodes were reported during the prophylaxis period.
- The historical control group had two thromboembolic events (deep vein thrombosis and pulmonary embolism).
Conclusions:
- Enoxaparin prophylaxis appears safe and effective in preventing L-asparaginase-associated thromboembolism in pediatric ALL patients.
- Pilot data supports further investigation in a randomized controlled trial for LMWH use in ALL therapy.
Abstract:
Forty-one consecutive children with acute lymphoblastic leukemia (ALL) received prophylaxis therapy with the low molecular weight heparin (LMWH) enoxaparin during L-asparaginase treatment. Enoxaparin was given every 24 h subcutaneously at a median dose of 0.84 mg/kg per day (range, 0.45-1.33 mg/kg per day) starting at the first dose of L-asparaginase until 1 week after the last dose. Molecular analysis for thrombophilic polymorphisms documented prothrombin G20210A mutation in 3/27 (11%), homozygosity for MTHFR C677T mutation in 5/27 (18.5%, and heterozygosity for factor V Leiden mutation in 5/27 (18.5%) children. There were no thrombotic events during 76 courses of L-asparaginase in 41 patients who had received enoxaparin. One patient suffered brain infarct 7 days after enoxaparin was stopped. There were no bleeding episodes. In a historical control group of 50 ALL children who had not received prophylactic enoxaparin during L-asparaginase treatment, two had thromboembolisms (one deep vein thrombosis and one pulmonary embolism). Enoxaparin is safe and seems to be effective in prevention of thromboembolism in ALL patients during L-asparaginase therapy. This study provides pilot data for a future randomized trial of the use of LMWH during ALL therapy for the prevention of asparaginase-associated thrombotic events.