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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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Anti-Xa levels in critically ill children receiving enoxaparin for venothromboembolism prophylaxis

Amanda M Marshall1, Taylor M Trussell2, Addison M Yee3

  • 1Children's Hospital & Medical Center/University of Nebraska Medicine Center, United States of America.

Thrombosis Research
|May 16, 2021
PubMed

Insights

Many children in pediatric intensive care units (PICUs) receiving enoxaparin for venous thromboembolism (VTE) prophylaxis unintentionally reach therapeutic anticoagulation levels. Routine anti-Xa monitoring is recommended for these pediatric patients.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Hematology

Background:

  • Venothrombolism (VTE) prophylaxis is common in pediatric intensive care units (PICUs).
  • Enoxaparin, a low-molecular weight heparin, is frequently used for VTE prophylaxis and therapeutic anticoagulation.
  • Current guidelines lack specific monitoring recommendations for enoxaparin in pediatric VTE prophylaxis.

Purpose of the Study:

  • To investigate the incidence of unintended therapeutic or supratherapeutic anti-Xa levels in pediatric patients receiving enoxaparin for VTE prophylaxis.
  • To determine if factors like dosing frequency, BMI, or creatinine levels correlate with anti-Xa levels.
  • To assess the clinical significance of these findings and the need for routine monitoring.

Main Methods:

  • Retrospective analysis of pediatric patients in PICUs receiving enoxaparin for VTE prophylaxis.
  • Measurement of serum anti-Xa levels during enoxaparin therapy.
  • Statistical analysis to identify correlations between anti-Xa levels and clinical factors, including blood urea nitrogen (BUN).

Main Results:

  • Over 20% of patients achieved therapeutic anti-Xa levels (0.5-1 units/mL).
  • Approximately 5% reached supratherapeutic anti-Xa levels (>1 units/mL).
  • Blood urea nitrogen (BUN) showed a positive odds ratio for achieving anti-Xa levels ≥ 0.5 units/mL.

Conclusions:

  • A significant proportion of pediatric patients on enoxaparin for VTE prophylaxis experience unintended therapeutic anticoagulation.
  • Routine serum anti-Xa level monitoring is warranted in this population to ensure safe and effective anticoagulation.
  • Further research may be needed to refine dosing strategies and monitoring protocols for pediatric VTE prophylaxis.

Keywords:
AnticoagulantsBlood coagulationCoagulation factor XaDeep venothromboembolism prophylaxisEnoxaparinHemorrhage

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