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Establishment of prophylactic enoxaparin dosing recommendations to achieve targeted anti-factor Xa concentrations in children with CHD

Published online by Cambridge University Press:  01 March 2018

Emily N. Israel ,
Christopher A. Thomas  and
Christopher W. Mastropietro
Emily N. Israel*
Affiliation:
Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA
Christopher A. Thomas
Affiliation:
Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
Christopher W. Mastropietro
Affiliation:
Section of Pediatric Cardiac Intensive Care, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
*
Author for correspondence: E. N. Israel, Department of Pharmacy Practice, Purdue University College of Pharmacy, 640 Eskenazi Avenue, Indianapolis, IN 46202, USA. Tel: 317 880 5409; E-mail: israele@purdue.edu
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Abstract

Background

Enoxaparin may be used to prevent central venous catheter-related thrombosis in patients with CHD. We aimed to determine whether current enoxaparin dosing regimens effectively achieve anti-factor Xa concentrations within prophylactic goal ranges in this patient population.

Methods

We implemented a formal protocol aimed at reducing central venous catheter-related thrombosis in children with CHD in January, 2016. Standard empiric prophylactic enoxaparin dosing regimens were used – for example, 0.75 mg/kg/dose every 12 hours for patients <2 months of age and 0.5 mg/kg/dose every 12 hours for patients ⩾2 months of age – with anti-factor Xa goal range of 0.25–0.49 IU/ml. Patients <2 years of age who received enoxaparin and had at least one valid steady-state anti-factor Xa measurement between 25 January, 2016 and 31 August, 2016 were retrospectively reviewed.

Results

During the study period, 47 patients had 186 anti-factor Xa concentrations measured, of which 20 (11%) were above and 112 (60%) were below the prophylactic goal range. Anti-factor Xa concentrations within the goal range were ultimately achieved in 31 patients. Median dose required to achieve anti-factor Xa concentrations within the prophylactic range was 0.89 mg/kg/dose (25, 75%: 0.75, 1.11) for patients <2 months (n=23 patients) and 0.79 mg/kg/dose (25, 75%: 0.62, 1.11) for patients ⩾2 months (n=8 patients).

Conclusions

Enoxaparin doses required to achieve prophylactic anti-factor Xa concentrations in young children with CHD were consistently higher than the currently recommended prophylactic dosing regimens. Further study is needed to determine whether dose titration to achieve prophylactic anti-factor Xa concentrations is effective in preventing central venous catheter-related thrombosis.

Keywords

Low-molecular-weight heparinanti-coagulationCHDprophylaxispaediatric
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 5 , May 2018 , pp. 715 - 718
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Copyright
© Cambridge University Press 2018 

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