Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-18T10:40:01.607Z Has data issue: false hasContentIssue false
  • English
  • Français

Do neonates, infants and young children need a higher dose of enoxaparin in the cardiac intensive care unit?

Published online by Cambridge University Press:  04 March 2010

Joan Sanchez de Toledo ,
Sriya Gunawardena ,
Ricardo Munoz ,
Richard Orr ,
Donald Berry ,
Sara Sonderman ,
Sara Krallman ,
Dana Shiderly ,
Li Wang  and
Peter Wearden
...Show all authors
Joan Sanchez de Toledo
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Sriya Gunawardena
Affiliation:
Department of Hematology and Oncology, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Ricardo Munoz
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Richard Orr
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Donald Berry
Affiliation:
Pharmacy Department, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Sara Sonderman
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Sara Krallman
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Dana Shiderly
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Li Wang
Affiliation:
Office of Clinical Research, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
Peter Wearden
Affiliation:
Department of Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Victor O. Morell
Affiliation:
Department of Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
Constantinos Chrysostomou*
Affiliation:
Division of Cardiac Intensive Care, Department of Pediatrics and Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
*
Correspondence to: Constantinos Chrysostomou, MD, Division of Cardiac Intensive Care, Department of Pediatrics & Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, Penn Avenue, 45th Street, 4th Floor, Pittsburgh, PA 15201. Tel: 412 692 7366; Fax: 412 692 5169; E-mail: Constantinos.Chrysostomou@chp.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Thromboembolic events are a serious complication occurring in critically ill children admitted to the cardiac intensive care unit. Although enoxaparin is one of the current anticoagulants of choice, dosages in children are extrapolated from adult guidelines. Recent data suggest that this population may need a higher dose than what is currently recommended to achieve target anti-factor Xa levels. The purpose of this study was to evaluate whether children less than 2 years old admitted to the cardiac intensive care unit require a higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.

Methods

Retrospective chart review including patients who received enoxaparin for the treatment or prophylaxis of venous thrombosis between January, 2005 and October, 2007. Patients were classified as younger and older as well as prophylactic and therapeutic on the basis of age and enoxaparin dose, respectively. Younger patients were those 2 month old or less and older patients were those older than 2 months of age.

Results

A total of 31 patients were identified; 13 (42%) were 2 months or younger and 25 (81%) were postoperative patients. Ten (32%) received prophylactic and 21 (68%) received therapeutic enoxaparin doses. To achieve optimal anti-factor Xa levels, enoxaparin dose was increased in all groups and reached statistical significance in all patients except those older than 2 months who received prophylactic enoxaparin. An average of 2.8 dosage adjustments was needed. No bleeding complications were reported.

Conclusions

Young children, infants, and neonates admitted to the cardiac intensive care unit required a significantly higher enoxaparin dose than that currently recommended to achieve target anti-factor Xa levels.

Keywords

Congenital cardiac diseaseanticoagulationlow molecular weight heparin
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 2 , April 2010 , pp. 138 - 143
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Monagle, P. Thrombosis in pediatric cardiac patients. Semin Thromb Hemost 2003; 29: 547–555.Google ScholarPubMed
2.Monagle, P, Karl, TR. Thromboembolic problems after the Fontan operation. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 36–47.CrossRefGoogle ScholarPubMed
3.AboulHosn, JA, Shavelle, DM, Castellon, Y, et al. Fontan operation and the single ventricle. Congenit Heart Dis 2007; 2: 2–11.CrossRefGoogle ScholarPubMed
4.Cholette, JM, Rubenstein, JS, Alfieris, GM, et al. Elevated risk of thrombosis in neonates undergoing initial palliative cardiac surgery. Ann Thorac Surg 2007; 84: 1320–1325.CrossRefGoogle ScholarPubMed
5.Kajimoto, H, Nakazawa, M, Murasaki, K, et al. Increased thrombogenesity in patients with cyanotic congenital heart disease. Circ J 2007; 71: 948–953.CrossRefGoogle ScholarPubMed
6.Monagle, P, Chalmers, E, Chan, A, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 887S–968S.CrossRefGoogle ScholarPubMed
7.Ho, SH, Wu, JK, Hamilton, DP, Dix, DB, Wadsworth, LD. An assessment of published pediatric dosage guidelines for enoxaparin: a retrospective review. J Pediatr Hematol Oncol 2004; 26: 561–566.CrossRefGoogle ScholarPubMed
8.Malowany, JI, Knoppert, DC, Chan, AKC, Pepelassis, D, Lee, DSC. Enoxaparin use in the neonatal intensive care unit: experience over 8 years. Pharmacotherapy 2007; 27: 1263–1271.CrossRefGoogle ScholarPubMed
9.Massicotte, P, Adams, M, Marzinotto, V, Brooker, LA, Andrew, M. Low-molecular-weight heparin in pediatric patients with thrombotic disease: a dose finding study. J Pediatr 1996; 128: 313–318.CrossRefGoogle ScholarPubMed
10.O’Brien, SH, Lee, H, Ritchey, AK. Once-daily enoxaparin in pediatric thromboembolism: a dose finding and pharmacodynamics/pharmacokinetics study. J Thromb Haemost 2007; 5: 1985–1987.CrossRefGoogle ScholarPubMed
11.Fareed, J, Hoppensteadt, D, Walenga, J, et al. Pharmacodynamic and pharmacokinetic properties of enoxaparin: implications for clinical practice. Clin Pharmacokinet 2003; 42: 1043–1057.CrossRefGoogle ScholarPubMed
12.Malowany, JI, Monagle, P, Knoppert, DC, et al. Enoxaparin for neonatal thrombosis: a call for a higher dose for neonates. Thromb Res 2008; 122: 826–830.CrossRefGoogle Scholar
13.Schwartz, G, Haycock, G, Edelmann, CJ, Spitzer, A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976; 58: 259–263.CrossRefGoogle ScholarPubMed
14.Schmugge, M, Risch, L, Huber, AR, Benn, A, Fischer, JE. Heparin-induced thrombocytopenia-associated thrombosis in pediatric intensive care patients. Pediatrics 2002; 109: E10.CrossRefGoogle ScholarPubMed
15.Bauman, ME, Belletrutti, MJ, Bajzar, L, et al. Evaluation of enoxaparin dosing requirements in infants and children. Better dosing to achieve therapeutic levels. Thromb Haemost 2009; 101: 86–92.Google ScholarPubMed
16.Bontadelli, J, Moeller, A, Schmugge, M, et al. Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease. Intensive Care Med 2007; 33: 1978–1984.CrossRefGoogle ScholarPubMed