Optimizing therapeutic enoxaparin in preterm neonates and infants

Area of Science:

• Neonatal Medicine
• Pharmacology
• Pediatric Thrombosis

Background:

• Enoxaparin is a low-molecular-weight heparin used for anticoagulation.
• Therapeutic anti-Xa levels are crucial for effective enoxaparin treatment.
• Dosing in preterm neonates and infants is not well-established.

Purpose of the Study:

• To determine the enoxaparin dose needed for preterm neonates and infants to achieve target anti-Xa levels.
• To evaluate the initial enoxaparin dose and its efficacy.
• To assess thrombotic events and bleeding in this population.

Main Methods:

• Retrospective chart review of preterm infants (<37 weeks gestation, <12 weeks postnatal age).
• Patients received subcutaneous enoxaparin every 12 hours with a target anti-Xa of 0.5-1 units/mL.
• Primary endpoint: enoxaparin dose to achieve therapeutic anti-Xa levels.

Main Results:

• Median enoxaparin dose required was 2 mg/kg subcutaneously every 12 hours.
• Initial dose of 1.7 mg/kg subcutaneously every 12 hours achieved therapeutic levels in 41% of patients.
• Thrombus progression occurred in 8%, new thrombi in 13%, and one case of pulmonary hemorrhage was reported.

Conclusions:

• Preterm neonates and infants require a median enoxaparin dose of 2 mg/kg subcutaneously every 12 hours for therapeutic anti-Xa levels.
• Current dosing guidelines may need adjustment for this population.
• Further research on optimal enoxaparin dosing in neonates is warranted.