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Published on: October 12, 2012
Intravenous Enoxaparin in Pediatric Burn Patients: A Case Series
Insights
Intravenous enoxaparin offers a safe and effective alternative for venous thromboembolism (VTE) prophylaxis in pediatric burn patients, overcoming limitations of the subcutaneous route. This approach ensures adequate anticoagulation without adverse events in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Burn Management
- Pharmacology
Background:
- Acute burns induce a hypercoagulable state, increasing venous thromboembolism (VTE) risk in pediatric patients.
- Enoxaparin, a low molecular weight heparin, is a common anticoagulant, but subcutaneous (SC) administration presents challenges in pediatric burn care.
- These challenges include pain, anxiety, variable absorption, and administration site difficulties, especially with extensive burns.
Observation:
- This case series evaluated three pediatric burn patients (ages 2, 8, and 10) with extensive burns (8-75% total body surface area) requiring VTE prophylaxis.
- Patients initially received SC enoxaparin but were transitioned to intravenous (IV) enoxaparin due to administration difficulties.
- All patients had central line access, facilitating IV drug delivery.
Findings:
- Intravenous enoxaparin achieved therapeutic anti-Xa peak concentrations (0.1-0.3 IU/mL) at doses of 0.35-0.5 mg/kg every 12 hours.
- No major bleeding events, adverse effects, or treatment failures were observed during the transition and IV administration period.
- IV enoxaparin demonstrated effective VTE prophylaxis in this pediatric burn cohort.
Implications:
- Intravenous enoxaparin administration is a viable and potentially preferable alternative to SC enoxaparin for VTE prophylaxis in pediatric burn patients.
- This route may improve drug delivery consistency and patient comfort, particularly in those with large body surface area burns.
- Further research into IV enoxaparin dosing and outcomes in this population is warranted to optimize VTE prevention strategies.
Abstract:
Patients with acute burns experience a hypercoagulable state that may necessitate the use of anticoagulants to prevent the complications of venous thromboembolism (VTE). Enoxaparin is a low molecular weight heparin that is commonly used for this purpose; however, the traditional SC route of administration poses potential limitations in the pediatric burn population. These include pain upon injection, increased anxiety, erroneous absorption and distribution, and difficulty in finding an administration site when burns encompass a large percentage of body surface area. As a result, the IV route of administration may be preferable in these patients. To date, a limited number of studies in critically ill pediatric patients have been performed. In this report, we present a case series of 3 pediatric burn patients who initially received SC enoxaparin and were transitioned to IV enoxaparin for VTE prophylaxis. The patients were 2, 8, and 10 years old. Burn involvement ranged from 8% to 75% total body surface area, and all patients had central line access. Adequate prophylactic low molecular weight heparin anti-Xa peak concentrations (0.1-0.3 international units/mL) were achieved with IV doses ranging from 0.35 to 0.5 mg/kg administered every 12 hours. No adverse effects, major bleeding events, or treatment failures occurred.
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