Rapid Enoxaparin Adjustment for Childhood Thrombosis/Thromboprophylaxis

Enoxaparin dosing in children is imperfect and strategies to optimize initial therapy for patients at high-thrombotic risk would be of clinical benefit. This study looked at using peak-post-first-enoxaparin-dose anti-Xa to guide subsequent enoxaparin dose and timing of administration in children deemed high-thrombotic risk. Fourteen patients (seven aged <3 months, seven children/adolescents) were identified and reviewed retrospectively. All patients were commenced on a therapeutic enoxaparin dose within ≤20 h with average time to therapeutic anti-Xa of 15.4 h (range 4-34 h) for neonates/infants and 10.8 h (range 4-24 h) for children/adolescents. No patient had supratherapeutic anti-Xa or thrombotic/bleeding events. Further studies are needed to validate this approach.