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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
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Outcomes of Prophylactic Enoxaparin Against Venous Thromboembolism in Hospitalized Children

Erin Bennett1, Claudia Delgado-Corcoran2,3, Christopher J Pannucci4

  • 1Section of Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Hospital Pediatrics
|May 9, 2022
PubMed

Insights

Prophylactic enoxaparin in hospitalized children effectively prevented hospital-acquired venous thromboembolism (HA-VTE) when guided by anti-Xa levels. This strategy demonstrated safety, with low rates of clinically relevant bleeding in pediatric patients.

Area of Science:

  • Pediatric pharmacology
  • Thrombosis and hemostasis
  • Hospital medicine

Background:

  • Hospitalized children face risks for venous thromboembolism (VTE).
  • Prophylactic anticoagulation, such as enoxaparin, is used to prevent hospital-acquired VTE (HA-VTE).
  • Optimizing enoxaparin dosing in pediatric populations is crucial for efficacy and safety.

Purpose of the Study:

  • To evaluate the biochemical and clinical outcomes of prophylactic enoxaparin in hospitalized children.
  • To assess the achievement of therapeutic anti-Xa levels and the incidence of HA-VTE and bleeding.

Main Methods:

  • Retrospective observational study of children (<18 years) receiving prophylactic enoxaparin.
  • Weight-based dosing with anti-Xa level-guided dose adjustments.
  • Primary outcomes: achieving goal anti-Xa range (0.2-0.5 IU/mL) and HA-VTE development.
  • Secondary outcome: clinically relevant bleeding.

Main Results:

  • 194 children were analyzed; 6.7% were infants (<1 year) and 93.3% were older children (≥1 year).
  • Older children (57.9%) were more likely to achieve goal anti-Xa levels than infants (11.1%) after initial dosing.
  • HA-VTE developed in 5.0% of older children and 15.4% of infants; achievement of goal anti-Xa levels was associated with lower HA-VTE rates (2.1% vs 13.6%).
  • Clinically relevant bleeding occurred in 2.1% of older children, with similar rates between those achieving and not achieving goal anti-Xa levels.

Conclusions:

  • An anti-Xa level-directed strategy for prophylactic enoxaparin is effective and safe in hospitalized children.
  • The strategy showed a reduction in HA-VTE when therapeutic anti-Xa levels were achieved.
  • Further investigation in prospective controlled studies is warranted to confirm these findings.
Abstract

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