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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
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

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

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