Research Abstracts

The Journal of Informed Pharmacotherapy 2004;15:405.

An Assessment of the Appropriateness of Published Pediatric Dosage Guidelines for Low Molecular Weight Heparin (Enoxaparin) in a Tertiary Care Institution

Sharon H. Ho, B.Sc.(Pharm), John K. Wu, MBBS, MSc, FRCPC, Donald P. Hamilton, B.Sc.(Pharm), David B. Dix, MBChB, FRCPC, and Louis D. Wadsworth, MB, ChB, FRCPath, FRCPC

Department of Pharmacy, Division of Hematology/Oncology/BMT, and Division of Hematopathology, British Columbia's Children's Hospital, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, Department of Pediatrics, and Department of Pathology, University of British Columbia, Vancouver, BC, Canada.

Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 2003.


Objectives

To evaluate the ability of published dosage guidelines for enoxaparin to achieve therapeutic anticoagulation and to determine whether the routine monitoring of anti-Xa levels is still necessary at a tertiary care pediatric institution. 

Setting

A major Canadian tertiary pediatric acute care teaching hospital.

Methods

Consecutive charts were reviewed for all patients receiving treatment doses of enoxaparin over a 4 year period (1998-2002). 

Results

Sixty-six percent (25/38) of the anti-Xa levels were within the recommended therapeutic range (0.5 - 1.0 (+ 10%) U/mL). The success rates of achieving therapeutic levels were 17%, 67%, 67%, 91%, and 67%, for patients < 2 months, >2 months - 1 year, >1-6 years, >6 - 12 years, and > 12 years of age, respectively. 

Thirty-seven percent of patients reported adverse effects. The most common effects were injection site related bruising and minor bleeds. One patient experienced a non-life threatening major bleed.

Conclusions

The majority of patients achieved therapeutic anticoagulation when dosed according to the published guidelines. Pediatric patients with cardiac conditions, renal insufficiency or who are younger than 2 months were more likely to require dosage adjustments to achieve the therapeutic range. Routine monitoring of anti-Xa levels may be necessary in these patient populations. Enoxaparin appears to be well tolerated in our patient population.


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