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Policy Adherence to Antithrombotic Therapy for Prophylactic Anticoagulation in Multisystem Inflammatory Syndrome in
Amanda A Clouser1, David Procaccini2, Courtney E Lawrence3
1Department of Pharmacy, Hackensack University Medical Center, Hackensack, NJ.
Insights
This study assessed adherence to guidelines for antithrombic therapy in children with multisystem inflammatory syndrome (MIS-C). An empiric enoxaparin dose of 0.5 mg/kg every 12 hours, with aspirin, showed zero venous thromboembolism events and one bleeding event.
Area of Science:
- Pediatric critical care medicine
- Pharmacology and therapeutics
- Infectious diseases
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition requiring careful management.
- Antithrombic therapy is crucial for preventing venous thromboembolism (VTE) in MIS-C patients.
- Standardizing antithrombic therapy protocols is essential for optimal patient outcomes.
Purpose of the Study:
- To evaluate the compliance of prescribing antithrombic therapy in pediatric patients diagnosed with MIS-C.
- To assess the effectiveness and safety of institutional guidelines for enoxaparin and aspirin use in MIS-C.
- To determine the optimal dosing of enoxaparin for VTE prophylaxis in this population.
Main Methods:
- A single-center, retrospective study was conducted.
- Infants and children diagnosed with MIS-C between May 2020 and January 2022 were included.
- Prescribing patterns, anti-Xa levels, and VTE/bleeding events were analyzed.
Main Results:
- 81% of MIS-C patients received enoxaparin prophylaxis with at least one anti-Xa level drawn.
- 40 patients (80%) met criteria for appropriately timed anti-Xa levels.
- An empiric enoxaparin dose of 0.5 mg/kg every 12 hours achieved therapeutic anti-Xa levels in 78% of patients and resulted in zero VTE events.
- Concomitant aspirin use was observed in 80% of patients.
Conclusions:
- The institutional guidelines for enoxaparin dosing (0.5 mg/kg every 12 hours) were adhered to in 80% of MIS-C patients.
- This dosing regimen, combined with aspirin, effectively prevented VTE events.
- The observed bleeding event rate was low, suggesting a favorable safety profile.
Objective:
The primary objective of this study was to characterize prescribing compliance with antithrombic therapy at a quaternary academic medical center per institutional multisystem inflammatory syndrome in children (MIS-C) guidelines.
Study Design:
This single-center, retrospective study evaluated infants and children with MIS-C who received antithrombotic therapies for venous thromboembolism prophylaxis between May 2020 and January 2022.
Results:
Of the 62 patients admitted with MIS-C during the study period, 50 (81%) received enoxaparin prophylaxis and had at least one anti-Xa level drawn. 40 patients met our institutional guideline criteria for having an appropriately timed anti-Xa. The median weight-based dose of enoxaparin needed to attain a low molecular weight heparin anti-Xa between 0.2 to 0.5 IU/mL was 0.5 mg/kg (±0.09 mg/kg) every 12 hours. 39 (78%) patients achieved a goal low molecular weight heparin anti-Xa with the initial guideline dosage. Forty patients (80%) received concomitant aspirin at a median dose of 3.1 mg/kg/d (IQR 1.6-25 mg/kg/d).
Conclusions:
Overall, 40 (80%) patients were started on enoxaparin per our center's institutional guidelines. Our study demonstrated an empiric enoxaparin dose of 0.5 mg/kg (maximum initial dose 60 mg) every 12 hours resulted in zero venous thromboembolism events. In conjunction with a median dose of 3.1 mg/kg/d of aspirin, these doses resulted in one bleeding event.
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