title: Evaluation of enoxaparin dosing requirements in infants and children. Better dosing to achieve therapeutic levels.
abstract: Increasing the starting dose of enoxaparin results in the early achievement of therapeutic anti-factor Xa levels in children receiving enoxaparin which is critical for effective therapy and the reduction of venipunctures. The aim of this study was: i) to determine the enoxaparin dose required to achieve therapeutic anti-factor Xa levels in infants and children, and ii) to establish whether increasing the starting dose of enoxaparin influenced the time required to reach the therapeutic range and the number of venipunctures required for dose-adjustment, and iii) the radiographic outcome of the thrombosis, where applicable. A retrospective chart review of children who received enoxaparin was carried out at the Stollery Children's Hospital, Edmonton, Alberta, Canada. Patients treated with standard-dose enoxaparin (1.5 mg/kg for children < or =3 months of age, 1.0 mg/kg for children > or =3 months of age), were compared with children who received a higher initial starting dose of enoxaparin (1.7 mg/kg for children > or =3 months of age, 1.2 mg/kg for children > or =3 months of age). Infants <3 months required an enoxaparin dose of 1.83 mg/kg, and those who received an increased initial enoxaparin dose resulted in faster attainment of therapeutic anti-factor Xa levels requiring significantly fewer venipunctures. Similarly, infants > or =3-12 months, 1-5 years, and 6-18 years, require enoxaparin 1.48 mg/kg, 1.23 mg/kg and 1.13 mg/kg, respectively, in order to achieve a therapeutic anti-factor Xa level. In conclusion, increasing the starting dose of enoxaparin may result in more rapid attainment of therapeutic range with fewer venipunctures, dose adjustments, and without an increase in adverse events.
authors.affiliation: Stollery Children's Hospital, 8440 112 Street, Edmonton, Alberta, T6G 2B7, Canada. mary.bauman@capitalhealth.ca
authors.forename: Mary E
authors.initials: ME
authors.lastname: Bauman
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Belletrutti
authors.forename: Laszlo
authors.initials: L
authors.lastname: Bajzar
authors.forename: Karina L
authors.initials: KL
authors.lastname: Black
authors.forename: Stefan
authors.initials: S
authors.lastname: Kuhle
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bauman
authors.forename: M
authors.initials: M
authors.lastname: Patricia Massicotte
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D065427:Factor Xa Inhibitors; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018962:Phlebotomy; D011859:Radiography; D012189:Retrospective Studies; D013927:Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents