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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
11:17

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

Published on: October 12, 2012

Fluctuations of anti-Xa concentrations during maintenance enoxaparin therapy for neonatal thrombosis

Mirjana Lulic-Botica1, Madhvi Rajpurkar, Cindy Sabo

  • 1Department of Pharmacy, Hutzel Women's Hospital, Detroit, MI, USA.

Acta Paediatrica (Oslo, Norway : 1992)
|January 4, 2012
PubMed

Insights

Anti-Xa concentrations frequently fluctuate in infants receiving enoxaparin for thrombosis, with therapeutic levels achieved sporadically. Despite this, enoxaparin demonstrates efficacy in resolving thrombosis in this population.

Area of Science:

  • Neonatal Medicine
  • Pediatric Thrombosis Management
  • Pharmacokinetics in Infants

Background:

  • Infants with thrombosis require anticoagulation, often with enoxaparin.
  • Monitoring anti-Xa levels is crucial for enoxaparin therapy in neonates.
  • Optimal dosing strategies for achieving therapeutic anti-Xa concentrations in infants are not well-established.

Purpose of the Study:

  • To evaluate anti-Xa concentration fluctuations in infants treated with enoxaparin for thrombosis.
  • To describe the clinical outcomes associated with enoxaparin therapy in this pediatric population.

Main Methods:

  • Retrospective chart review of infants treated with enoxaparin in a Neonatal Intensive Care Unit.
  • Abstraction of data including enoxaparin doses, anti-Xa concentrations, and clinical outcomes.
  • Analysis of 143 anti-Xa concentrations from 26 infants.

Main Results:

  • Therapeutic anti-Xa levels (0.5-1 U/mL) were achieved at a mean dose of 2.1 mg/kg, but only 27% of all measured concentrations were therapeutic.
  • During maintenance therapy, 40% of anti-Xa concentrations were within the therapeutic range.
  • Clot resolution was observed in 81% of infants, with minor bleeding in 4 and intracranial bleeding in 1; four infants died.

Conclusions:

  • Anti-Xa concentrations exhibit significant fluctuations during maintenance enoxaparin therapy in infants.
  • Enoxaparin appears effective for thrombosis resolution in infants, despite challenges in maintaining therapeutic anti-Xa levels.
  • Further research is needed to optimize enoxaparin dosing and monitoring for improved outcomes in neonates.
Abstract

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