Jeffrey J Cies1, Laura Santos, Arun Chopra. 1. 1Department of Pharmacy, St. Christopher's Hospital for Children, Philadelphia, PA. 2Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA. 3Department of Pharmacy, Alfred I duPont Hospital for Children, Wilmington, DE. 4Department of Pediatrics, Section of Critical Care Medicine NYU Langone Medical Center and NYU School of Medicine, New York, NY. 5Department of Pediatrics, Section of Critical Care Medicine, St. Christopher'sHospital for Children and Drexel University College of Medicine, Philadelphia, PA.
Abstract
OBJECTIVES: To report our experience with the use of IV enoxaparin in neonatal and pediatric patients in the ICU. DESIGN: We performed a case control from January 1, 2009, to June 30, 2012, comparing patients that received IV enoxaparin to controls that received subcutaneous enoxaparin. Cases were matched to controls in a 1:2 manner. IV enoxaparin doses were infused over 30 minutes and anti-Factor Xa levels were drawn 4 hours after the start of the IV infusion or 4 hours after a subcutaneous dose. SETTING: The pediatric and cardiac ICUs of a tertiary/quaternary, free-standing, academic children's hospital. PATIENTS: Forty-five neonatal and pediatric patients receiving prophylactic or therapeutic enoxaparin. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Fifteen cases and 30 controls were included. Of 15 patients, 13 received IV enoxaparin for treatment and two received IV enoxaparin for prophylaxis as compared with 25 of 30 controls receiving subcutaneous enoxaparin for treatment and five receiving subcutaneous enoxaparin for prophylaxis. The ages for the cases ranged from 21 days to 16 years with a median weight of 5 kg, and the ages for controls ranged from 10 days to 23 years with a median weight of 31 kg. The median duration of IV therapy was 11 days (range, 1-120 d) and the median duration for subcutaneous therapy was 15 days (range, 3-85 d). The mean initial IV dose was 1.14 ± 0.38 mg/kg/dose q12h, and the mean initial subcutaneous dose was 0.85 ± 0.2 mg/kg/dose subcutaneous q12h (p = 0.003). The mean therapeutic IV dose was 1.31 ± 0.52 mg/kg/dose q12h, and the mean therapeutic subcutaneous dose was 0.9 ± 0.3 mg/kg/dose q12h (p = 0.016). There were no adverse events reported related to bleeding, thrombosis, or hypersensitivity in any of the cases or controls evaluated. CONCLUSION: The pharmacodynamics of a 30-minute IV enoxaparin infusion was found to produce therapeutic 4 hour anti-Factor Xa levels similar to subcutaneous doses. Although this was a small study, there were no adverse events, suggesting the safety profile of IV enoxaparin may be similar to subcutaneous dosing with the added benefit of less pain associated with IV dosing. These findings suggest that IV enoxaparin may be a viable option for anticoagulating critically ill children and its use warrants further study.
OBJECTIVES: To report our experience with the use of IV enoxaparin in neonatal and pediatric patients in the ICU. DESIGN: We performed a case control from January 1, 2009, to June 30, 2012, comparing patients that received IV enoxaparin to controls that received subcutaneous enoxaparin. Cases were matched to controls in a 1:2 manner. IV enoxaparin doses were infused over 30 minutes and anti-Factor Xa levels were drawn 4 hours after the start of the IV infusion or 4 hours after a subcutaneous dose. SETTING: The pediatric and cardiac ICUs of a tertiary/quaternary, free-standing, academic children's hospital. PATIENTS: Forty-five neonatal and pediatric patients receiving prophylactic or therapeutic enoxaparin. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Fifteen cases and 30 controls were included. Of 15 patients, 13 received IV enoxaparin for treatment and two received IV enoxaparin for prophylaxis as compared with 25 of 30 controls receiving subcutaneous enoxaparin for treatment and five receiving subcutaneous enoxaparin for prophylaxis. The ages for the cases ranged from 21 days to 16 years with a median weight of 5 kg, and the ages for controls ranged from 10 days to 23 years with a median weight of 31 kg. The median duration of IV therapy was 11 days (range, 1-120 d) and the median duration for subcutaneous therapy was 15 days (range, 3-85 d). The mean initial IV dose was 1.14 ± 0.38 mg/kg/dose q12h, and the mean initial subcutaneous dose was 0.85 ± 0.2 mg/kg/dose subcutaneous q12h (p = 0.003). The mean therapeutic IV dose was 1.31 ± 0.52 mg/kg/dose q12h, and the mean therapeutic subcutaneous dose was 0.9 ± 0.3 mg/kg/dose q12h (p = 0.016). There were no adverse events reported related to bleeding, thrombosis, or hypersensitivity in any of the cases or controls evaluated. CONCLUSION: The pharmacodynamics of a 30-minute IV enoxaparin infusion was found to produce therapeutic 4 hour anti-Factor Xa levels similar to subcutaneous doses. Although this was a small study, there were no adverse events, suggesting the safety profile of IV enoxaparin may be similar to subcutaneous dosing with the added benefit of less pain associated with IV dosing. These findings suggest that IV enoxaparin may be a viable option for anticoagulating critically ill children and its use warrants further study.