Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease.
OBJECTIVE
To investigate efficacy and safety of enoxaparin for catheter-related arterial thrombosis in infants with congenital heart disease.


METHODS
Prospective observational study.


METHODS
Pediatric Intensive Care and Cardiology Unit at the University Children's Hospital of Zurich.


METHODS
A cohort of 32[Symbol: see text]infants aged 0-12[Symbol: see text]months treated with enoxaparin for catheter-related arterial thrombosis from 2002 to 2005.


METHODS
Dose requirements of enoxaparin, resolution of thrombosis by Doppler ultrasound, and bleeding complications.


RESULTS
Catheter-related arterial thrombosis was located in the iliac/femoral arteries in 31 (97%) infants and aorta in 1 infant, and was related to indwelling catheters and cardiac catheterization in 17 (53%) and 15 (47%) cases, respectively. Newborns required increased doses of enoxaparin to achieve therapeutic anti-FXa levels (mean 1.62[Symbol: see text]mg/kg per dose) compared with infants aged 2-12 months (mean 1.12 mg/kg per dose; p=0.0002). Complete resolution of arterial thrombosis occurred in 29 (91%) infants at a mean of 23 days after initiation of enoxaparin therapy. Partial or no resolution was observed in 1 (3%) and 2 (6%) infants, respectively, at a mean follow-up time of 4.3 months. Bleeding complications occurred in 1 (3%) infant.


CONCLUSIONS
Enoxaparin is efficient and safe for infants with congenital heart disease and catheter-related arterial thrombosis, possibly representing a valid alternative to the currently recommended unfractionated heparin.
Bontadelli
Joe
J
Division of Pediatrics, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
Moeller
Alexander
A
Schmugge
Markus
M
Schraner
Thomas
T
Kretschmar
Oliver
O
Bauersfeld
Urs
U
Bernet-Buettiker
Vera
V
Albisetti
Manuela
M
D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D006328:Cardiac Catheterization / Q000009:adverse effects; D015331:Cohort Studies; D003328:Coronary Thrombosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D017063:Outcome Assessment, Health Care; D013557:Switzerland / Q000453:epidemiology
D000925:Anticoagulants; D017984:Enoxaparin