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

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Establishment of prophylactic enoxaparin dosing recommendations to achieve targeted anti-factor Xa concentrations in

Emily N Israel1, Christopher A Thomas1, Christopher W Mastropietro2

  • 11Department of Pharmacy,Riley Hospital for Children at Indiana University Health,Indianapolis,IN,USA.

Cardiology in the Young
|March 2, 2018
PubMed

Insights

Standard enoxaparin doses are insufficient for preventing thrombosis in pediatric patients with congenital heart disease (CHD). Higher enoxaparin doses are needed to achieve therapeutic anti-factor Xa levels in this population.

Area of Science:

  • Pediatric Cardiology
  • Pharmacology
  • Thrombosis Prevention

Background:

  • Congenital heart disease (CHD) patients often require central venous catheters.
  • Catheter-related thrombosis is a significant complication in these patients.
  • Enoxaparin is used for prophylaxis, but optimal dosing is unclear.

Purpose of the Study:

  • To evaluate the effectiveness of current enoxaparin prophylactic dosing regimens.
  • To determine if standard doses achieve target anti-factor Xa concentrations in pediatric CHD patients.
  • To assess enoxaparin's role in preventing central venous catheter-related thrombosis.

Main Methods:

  • Retrospective review of pediatric patients (<2 years) with CHD receiving enoxaparin.
  • Analysis of anti-factor Xa concentrations against a prophylactic goal range (0.25-0.49 IU/ml).
  • Evaluation of standard empiric enoxaparin doses (0.75 mg/kg/dose <2 months, 0.5 mg/kg/dose ⩾2 months).

Main Results:

  • Only 31 out of 47 patients achieved target anti-factor Xa levels.
  • A significant proportion (60%) had sub-therapeutic levels.
  • Higher median doses were required: 0.89 mg/kg/dose for <2 months and 0.79 mg/kg/dose for ⩾2 months.

Conclusions:

  • Current enoxaparin prophylactic dosing regimens are inadequate for pediatric CHD patients.
  • Higher doses are necessary to reach target anti-factor Xa concentrations.
  • Further research is needed to confirm if dose titration prevents thrombosis.
Abstract

Keywords:
CHDLow-molecular-weight heparinanti-coagulationpaediatricprophylaxis

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