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Updated: Nov 29, 2025

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

Published on: October 12, 2012

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Evaluation of a Pediatric Enoxaparin Dosing Protocol and the Impact on Clinical Outcomes

Kayla Wiltrout1, Jennifer Lissick1, Mike Raschka1

  • 1Department of Pharmacy (KW, JL, MR), Children's Minnesota, Minneapolis, MN.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|November 20, 2020
PubMed

Insights

Pediatric enoxaparin dosing needs adjustment. Current protocols achieve therapeutic anti-factor Xa (anti-Xa) levels only 55.8% of the time, impacting thrombus resolution. More aggressive dosing is recommended for better outcomes.

Area of Science:

  • Pediatric pharmacology
  • Thromboembolism treatment
  • Pharmacokinetics

Background:

  • Enoxaparin is used for pediatric thromboembolism, but optimal dosing remains debated.
  • Current dosing guidelines may be too conservative, limiting efficacy in younger children.
  • Limited data exists on escalated enoxaparin doses in pediatric patients.

Purpose of the Study:

  • Identify patient factors associated with anti-factor Xa (anti-Xa) levels.
  • Determine the relationship between initial anti-Xa levels and thrombus resolution.
  • Assess bleeding risks associated with enoxaparin therapy.

Main Methods:

  • Retrospective cohort study of 283 pediatric patients (≤18 years).
  • Patients received therapeutic subcutaneous enoxaparin for incident thrombus.
  • Data collected from October 2008 to October 2018.

Main Results:

  • Therapeutic anti-Xa levels achieved on initial lab evaluation correlated with successful thrombus resolution.
  • Age, BMI, and specific diagnoses were associated with initial anti-Xa values.
  • Bleeding rates were similar across different anti-Xa concentrations.

Conclusions:

  • The current enoxaparin dosing nomogram achieves therapeutic anti-Xa levels in only 55.8% of pediatric patients.
  • Delayed achievement of therapeutic anti-Xa levels negatively impacts thrombus resolution.
  • A more aggressive enoxaparin dosing strategy is necessary for improved clinical outcomes in children.
Abstract

Keywords:
CHESTanticoagulationdrug monitoringenoxaparinlow-molecular-weight heparinpediatricthrombus

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