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Published on: October 12, 2012
Low-Molecular-Weight Heparin and Fondaparinux Use in Pediatric Patients With Obesity
Michael P Garner1, Chimnonso P Onuoha1, Norman E Fenn1
1The University of Texas at Tyler, TX, USA.
Insights
Pediatric patients with obesity may need adjusted enoxaparin doses. This review found potential under- or overdosing in children with obesity, highlighting the need for further research on low-molecular-weight heparins (LMWHs) and fondaparinux.
Area of Science:
- Pediatric pharmacology
- Thrombotic disorders
Background:
- Obesity is increasingly prevalent in pediatric populations.
- Anticoagulant therapy is crucial for managing thrombotic events in children.
- Specific dosing considerations for obese pediatric patients are not well-established for all anticoagulants.
Purpose of the Study:
- To review the efficacy and safety of low-molecular-weight heparins (LMWHs) and fondaparinux in pediatric patients with obesity.
- To identify potential dosing discrepancies and clinical outcomes in this specific patient group.
Main Methods:
- A comprehensive literature search was performed across multiple databases (PubMed, SCOPUS, etc.) from 1900 to July 2020.
- Search terms included various LMWHs, fondaparinux, and pediatric obesity-related terms.
- Studies involving pediatric patients with overweight or obesity using LMWHs or fondaparinux were included.
Main Results:
- Twelve studies were included from 207 screened.
- Enoxaparin dosing adjustments showed variable results, with potential under- or overdosing in pediatric patients with obesity compared to normal weight.
- Four thrombotic and 15 bleeding events were reported; trends for dalteparin and fondaparinux were inconclusive.
Conclusions:
- Pediatric patients with obesity may require proactive enoxaparin dose adjustments.
- Further research is needed for dalteparin and fondaparinux in pediatric obesity.
- Thrombotic and bleeding event rates were comparable to adult outcomes, but monitoring remains a clinical controversy.
Objective:
The objective of this study is to comprehensively review the efficacy and safety data of low-molecular-weight heparins (LMWHs) and fondaparinux in pediatric patients with obesity.
Data Sources:
A comprehensive literature search of PubMed, SCOPUS, CINAHL, Academic Search Complete, PsycInfo, Cochrane Library, and Web of Science databases was conducted (1900 to July 2020). Search terms utilized included LMWH, low-molecular-weight heparin, enoxaparin, dalteparin, tinzaparin, fondaparinux, pediatric, child, children, obese, obesity, overweight. No limits or timeline restrictions were imposed.
Study Selection And Data Extraction:
Studies that reported pediatric patients with described overweight or obesity and utilized LMWHs or fondaparinux were considered.
Data Synthesis:
Of 207 studies screened, 12 were included. Average dose reductions of 12.9% to 37.3% from the starting dose were observed with treatment indications of enoxaparin and increased up to 27.3% for prophylactic indications. Trends could not be concluded in the dalteparin and fondaparinux studies. Four thrombotic and 15 bleeding events were reported in the studies.
Relevance To Patient Care And Clinical Practice:
Pediatric patients with obesity may initially be underdosed or overdosed with enoxaparin compared with children with healthy body weight, depending on the indication.
Conclusion:
Pediatric patients with obesity may benefit from proactively adjusting enoxaparin dosing on initiation of therapy. Further studies are needed for dalteparin and fondaparinux in these populations. Clinical controversy exists with the relevance of monitoring these high-risk medications for therapeutic and prophylactic indications. Thrombotic and hemorrhagic events were similar to reported adult outcomes.
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