Initial experience of enoxaparine as anticoagulant during mechanical circulatory support in children

Area of Science:

• Pediatric Cardiology
• Cardiovascular Surgery
• Pharmacology

Background:

• Unfractionated heparin is the standard anticoagulant for mechanical circulatory support.
• Limited data exists on alternative anticoagulants in pediatric mechanical circulatory support.

Purpose of the Study:

• To evaluate the initial experience of using subcutaneous enoxaparin for anticoagulation in children with mechanical circulatory support.
• To compare outcomes between enoxaparin and unfractionated heparin in this population.

Main Methods:

• Retrospective analysis of nine consecutive children treated with Berlin Heart mechanical support.
• Three children received enoxaparin; six historical controls received unfractionated heparin.
• Outcomes assessed included survival, bleeding, thromboembolic events, and blood product consumption.

Main Results:

• All children treated with enoxaparin survived without significant bleeding or thromboembolic events.
• Children on enoxaparin required less daily substitution of platelets, red blood cells, fresh frozen plasma, and anti-thrombin III concentrate.
• Four out of six children on unfractionated heparin died.

Conclusions:

• Subcutaneous enoxaparin appears to be a promising anticoagulant for pediatric mechanical circulatory support.
• Enoxaparin demonstrated a favorable safety profile with reduced bleeding and blood product consumption compared to unfractionated heparin.
• Further prospective studies are warranted to confirm these findings.