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Clinical experiences with low-molecular weight heparins in pediatric patients
S Hofmann1, R Knoefler, N Lorenz
1Department of Pediatrics, University Hospital of Technical University, Fetscherstrasse 74, D-01307 Dresden, Germany.
Insights
Low-molecular weight heparins (LMWHs) are safe and effective for preventing and treating blood clots in children. This retrospective analysis of 79 children shows LMWHs are particularly useful for short-term prophylaxis after surgery or trauma.
Area of Science:
- Pediatric Thrombosis
- Pharmacology
- Hematology
Background:
- Thromboembolic events pose risks in children, especially post-surgery or trauma.
- Low-molecular weight heparins (LMWHs) are increasingly used in pediatric anticoagulation.
- Limited data exists on LMWH efficacy and safety in diverse pediatric populations.
Purpose of the Study:
- To retrospectively analyze the efficacy and safety of two LMWHs (nadroparin and enoxaparin) in pediatric patients.
- To evaluate LMWH use for short-term prophylaxis, long-term prophylaxis, and initial treatment of thromboembolic events.
- To assess outcomes based on different treatment durations and indications.
Main Methods:
- Retrospective analysis of 79 children (2 weeks to 19 years) treated with nadroparin or enoxaparin.
- Categorization of patients into short-term prophylaxis (n=62), long-term prophylaxis (n=13), and initial treatment groups (n=4).
- Review of treatment protocols, dosages (including anti-factor Xa activity), and clinical outcomes.
Main Results:
- No thrombosis occurred in patients receiving short-term LMWH prophylaxis.
- Positive outcomes (no reocclusion, recanalization) observed in children treated with LMWHs after thrombolytic therapy or unfractionated heparin (UFH).
- Minimal side effects (gastrointestinal bleeding, hair loss) reported in two patients, indicating a favorable safety profile.
Conclusions:
- LMWHs demonstrate efficacy and safety in pediatric thromboembolic event prophylaxis and treatment.
- Nadroparin was used without body weight adjustment or anti-FXa monitoring for short-term prophylaxis.
- Long-term prophylaxis and treatment doses were guided by anti-FXa activity, showing good clinical results.
Abstract:
The courses of 79 children (2 weeks to 19 years old) treated with two different low-molecular weight heparins (LMWHs)--nadroparin (n=66) and enoxaparin (n=13)--were retrospectively analysed. In 62 patients, LMWHs were given for short-term prophylaxis (1-2 weeks) during immobilization after surgery or trauma. Thirteen children with thromboembolic events received long-term prophylaxis with LMWHs for 2-18 months--six after thrombolytic therapy and seven after therapy with unfractionated heparin (UFH). Because of thromboembolic events, four patients were initially treated with LMWHs. In all patients with short-term prophylaxis, no thrombosis occurred. After thrombolytic therapy, three children had no reocclusion, two had no thrombus apposition and one had complete recanalization. In the seven patients treated with LMWHs after UFH, four had no reocclusion, two had recanalization and one had reocclusion. In all patients receiving LMWHs for initial treatment of thrombosis, no thrombus apposition, but also no recanalization, occurred. For short-term prophylaxis, nadroparin was used independent of the body weight and without determination of anti-factor Xa (anti-FXa) activity. Long-term prophylaxis was given mainly as doses of 45-100 anti-FXa U/kg resulting in anti-FXa activities between 0.2 and 0.4 U/ml. For treatment of thrombosis, doses of 200-300 anti-FXa U/kg corresponded to 0.5-1.0 anti-FXa U/ml. Side effects--slight gastrointestinal bleeding and temporary reversible hair loss--were seen in two patients. In conclusion, LMWHs proved to be efficacious and safe especially in prophylaxis of thromboembolic events in children.