title: A retrospective analysis of outcomes of dalteparin use in pediatric patients: a single institution experience.
abstract: BACKGROUND
  Dalteparin is a commonly used low molecular weight heparin (LMWH) with extensive safety data in adults. With distinct advantages of once daily dosing and relative safety in renal impairment, it has been used off-label in pediatric practice; however, age-based dosing guidelines, safety and efficacy data in children are evolving.
  
  
  OBJECTIVE
  To report our institutional experience with the use of dalteparin in the treatment and prophylaxis of venous thromboembolism (VTE) in pediatric patients.
  
  
  METHODS
  Retrospective chart review of all children (0-18years) that received dalteparin from December 1, 2000 through December 31, 2011. Doses per unit body weight per day (units/kg/day) were calculated for age-based group comparisons.
  
  
  RESULTS
  Of 166 patients identified, 116 (70%) received prophylactic doses while 50 (30%) received therapeutic doses of dalteparin. Infants (<1year) required significantly higher weight-based dosing to achieve therapeutic anti-Xa levels compared to children (1-10years) or adolescents (>10-18years) (mean dose units/kg/day; 396.6 versus 236.7 and 178.8 respectively, p<0.0001). Overall response rate, including complete and partial thrombus resolution, was 83%. Bleeding complications were minor and the rates were similar in therapeutic and prophylaxis patients. No significant differences in dosing or bleeding events were noted based on obesity or malignancy.
  
  
  CONCLUSIONS
  In our experience, dalteparin is effective for prophylaxis and therapy of VTE in pediatric patients. Dosing should be customized in an age-based manner with close monitoring of anti-Xa activity in order to achieve optimal levels, prevent bleeding complications, and to allow full benefit of prevention or therapy of thrombotic complications.
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States; Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: warad.deepti@mayo.edu.
authors.forename: Deepti
authors.initials: D
authors.lastname: Warad
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Amulya Nageswara
authors.initials: AN
authors.lastname: Rao
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Trey
authors.initials: T
authors.lastname: Mullikin
authors.affiliation: Mayo Pharmacy Services, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Kevin
authors.initials: K
authors.lastname: Graner
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: William J
authors.initials: WJ
authors.lastname: Shaughnessy
authors.affiliation: Special Coagulation Laboratory, Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Pruthi
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, United States.
authors.forename: Vilmarie
authors.initials: V
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017985:Dalteparin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017985:Dalteparin
keywords: Children; Dalteparin; Dose; Low molecular weight heparin; Pediatric; Safety