Enoxaparin for neonatal thrombosis: a call for a higher dose for neonates.
BACKGROUND
Enoxaparin is the current anticoagulant of choice for neonatal thrombosis. Present neonatal treatment guidelines of 1.5 mg/kg every 12 hours (q12 h) are extrapolated primarily from an earlier study with 9 infants less than 2 months of age. More recent studies indicate an increased dose requirement for neonates.


METHODS
Relevant data from articles and abstracts were identified by searching MEDLINE and pediatric and hematology conference proceedings.


RESULTS
Publications between 1996 and 2007 included 8 papers, 4 abstracts and 1 review article with primary research documenting enoxaparin use in 240 neonates. The mean maintenance dose of enoxaparin ranged from 1.48 to 2.27 mg/kg q12 h for all infants, but was higher for preterm neonates at 1.9-2.27 mg/kg q12 h. The efficacy of enoxaparin, causing either complete or partial resolution was between 59 and 100%. Minor side effects were common and adverse events (major bleeding) occurred in 12 patients (0-19%).


CONCLUSIONS
Increased experience with enoxaparin use in neonates in the past decade has indicated higher doses to achieve accepted target anti-factor Xa values. The long-term use of indwelling catheters (Insuflon catheter) for enoxaparin administration may need to be reevaluated in ELBW infants. Suggested starting doses of enoxaparin are 1.7 mg/kg q12 h for term neonates and 2.0 mg/kg q12 h for preterm neonates if there is no considerable bleeding risk. However, further prospective studies are needed to validate an increased initial dose of enoxaparin.
Malowany
Janet I
JI
Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada N6A 5C1.
Monagle
Paul
P
Knoppert
David C
DC
Lee
David S C
DS
Wu
John
J
McCusker
Patricia
P
Massicotte
M Patricia
MP
Williams
Suzan
S
Chan
Anthony K C
AK
D000925:Anticoagulants / Q000627:therapeutic use*; D002408:Catheters, Indwelling; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D013927:Thrombosis / Q000188:drug therapy*
D000925:Anticoagulants; D017984:Enoxaparin