Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

Bontadelli, J.; Moeller, Alexander; Schmugge, Markus; Schraner, Thomas; Kretschmar, Oliver; Bauersfeld, Urs; Bernet‐Buettiker, Vera; Albisetti, Manuela

doi:10.1007/s00134-007-0718-8

Cited by 43 publications

(35 citation statements)

References 25 publications

(27 reference statements)

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“…100,101,[103][104][105][106][107][108][109][110][111] One study reported oncedaily and bid enoxaparin targeted to a range of 0.5 to 0.8 units/mL measured 2 h after dose. 52 The relationship between the target therapeutic range and the clinical outcomes is unknown in neonates.…”

Section: 4-25 Cvad Prophylaxis In Neonatesmentioning

confidence: 99%

“…238 A recent report suggested that LMWH may be a safe alternative in this situation, although the possible need for thrombolysis or surgery makes LMWH a less attractive option. 103 If , 4 h have passed since the CC-related UFH bolus was given, then UFH may be commenced as a continuous infusion without a bolus. In acute limb-threatening thrombosis, indirect evidence from adults supports the use of thrombolytic or surgical interventions.…”

Section: 9-210 Therapy For Femoral Artery Thrombosis In Neonates Amentioning

confidence: 99%

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Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,241

559

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Section: 4-25 Cvad Prophylaxis In Neonatesmentioning

confidence: 99%

Section: 9-210 Therapy For Femoral Artery Thrombosis In Neonates Amentioning

confidence: 99%

Antithrombotic Therapy in Neonates and Children

Monagle

Chan

Goldenberg

et al. 2012

Chest

1,241

559

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“…A previous study of 31 children reported that a mean dose of 0AE83 mg/kg twice-daily for neonates and 0AE62 mg/kg twice-daily for children older than 2 months was required to achieve target range (Dix et al, 2000). In addition, a recent study reported that increasing the starting dose of enoxaparin may result in a more rapid achievement of the therapeutic range and fewer dose adjustments (Bauman et al 2009).The majority of studies of enoxaparin in children have reported a higher treatment dose requirement to achieve antiXa target range (0AE5-1AE0 i/u/ml), particularly in neonates, as compared to adults (Dix et al, 2000;McCusker et al, 2003;Streif et al, 2003;Ho et al, 2004;Manco-Johnson, 2006, Bontadelli et al, 2007Malowany et al, 2007). A number of studies further reported an increased dose requirement in …”

mentioning

confidence: 99%

Dosing and monitoring of enoxaparin (Low molecular weight heparin) therapy in children

et al. 2010

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Low molecular weight heparins (LMWHs) are commonly used in paediatric tertiary institutions for primary prophylaxis and treatment of thromboembolic events. This probably reflects the assumption that LMWHs have increased dose-response predictability compared to other anticoagulants, such as unfractionated heparin and warfarin.The 8th American College of Chest Physicians (ACCP) guidelines for therapeutic and prophylactic use of LMWH are based on anti-activated factor X (Xa) ranges of 0AE5-1AE0 and 0AE1-0AE3 u/ml, respectively (Monagle et al, 2008). These ranges are extrapolated from adult guidelines and are based on anti-Xa levels measured 4-6 h post-subcutaneous injection. The ACCP suggests prophylactic doses of 0AE75 mg/kg twice-daily and 0AE5 mg/kg twice-daily for neonates and children older than 2 months respectively, to achieve the therapeutic range (Monagle et al, 2008); whereas the guidelines for enoxaparin-based treatment of thrombosis are based on a study of 25 children, which recommended a dose of 1AE5 mg/kg twice daily for neonates <2 months and 1AE0 mg/kg twice daily for children older than 2 months of age (Massicotte et al, 1996;Monagle et al, 2008). A previous study of 31 children reported that a mean dose of 0AE83 mg/kg twice-daily for neonates and 0AE62 mg/kg twice-daily for children older than 2 months was required to achieve target range (Dix et al, 2000). In addition, a recent study reported that increasing the starting dose of enoxaparin may result in a more rapid achievement of the therapeutic range and fewer dose adjustments (Bauman et al 2009).The majority of studies of enoxaparin in children have reported a higher treatment dose requirement to achieve antiXa target range (0AE5-1AE0 i/u/ml), particularly in neonates, as compared to adults (Dix et al, 2000;McCusker et al, 2003;Streif et al, 2003;Ho et al, 2004;Manco-Johnson, 2006, Bontadelli et al, 2007Malowany et al, 2007). A number of studies further reported an increased dose requirement in SummaryLow molecular weight heparins (LMWHs) are commonly used in paediatric tertiary institutions for primary prophylaxis and treatment of thromboembolic events. Despite this widespread use, the therapeutic and prophylactic guidelines for LMWH therapy in children are extrapolated from adult guidelines. In fact, there is very little information regarding the pharmacokinetics, clinical effectiveness, adverse event profile and optimal dose schedule for LMWH therapy in children. This study was designed to determine whether paediatric-specific dosage requirements for LMWH are justified, by investigating the doses required to achieve target therapeutic ranges. Patients who were treated with enoxaparin between October 2003 and July 2007 were identified for inclusion in this study. One hundred forty patients had an anti-activated factor X assay result with a total of 55 (39%) patients achieving therapeutic levels 4-6 h post dose. Children younger than 1 year required the highest dose of enoxaparin/kg and highest number of dose changes to achieve the target th...

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“…Enoxaparin has been demonstrated to be effective in the treatment of catheter-associated arterial thrombosis in pediatric patients with congenital heart disease (30,31). In addition, Enoxaparin has been associated with a reduction in the risk of thrombotic complications when compared with no therapy in one study of pediatric patients with single ventricle cardiac lesions after initial palliation (stage I) and after superior cavopulmonary connection (stage II) (32).…”

Section: Moamentioning

confidence: 98%