Anti-Xa levels in critically ill children receiving enoxaparin for venothromboembolism prophylaxis.

Autor: Marshall AM; Children's Hospital & Medical Center/University of Nebraska Medicine Center, United States of America. Electronic address: amamarshall@childrensomaha.org., Trussell TM; Cincinatti Children's Hospital, United States of America., Yee AM; The University of Arkansas for Medical Sciences/Arkansas Children's Hospital, United States of America., Malone MP; The University of Arkansas for Medical Sciences/Arkansas Children's Hospital, United States of America.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2021 Jul; Vol. 203, pp. 117-120. Date of Electronic Publication: 2021 May 01.
DOI: 10.1016/j.thromres.2021.04.019
Abstrakt: Venothrombolism (VTE) prophylaxis is increasingly utilized in pediatric intensive care units (PICUs). Enoxaparin, a low-molecular weight heparin, is frequently used for this purpose. Enoxaparin can also be used for therapeutic anticoagulation in cases of known thrombus. In such cases, monitoring involves obtaining serum anti- Xa levels with a target value of 0.5-1 units/mL. No monitoring recommendations currently exist for enoxaparin when intended for pediatric VTE prophylaxis. We hypothesize that a clinically important number of patients on VTE prophylaxis with enoxaparin have serum anti-Xa levels consistent with values targeted for therapeutic anticoagulation. We found that over 20% of patients on VTE prophylaxis with enoxaparin had serum anti-Xa levels consistent with true therapeutic anticoagulation (anti-Xa level 0.5-1 units/mL) during their enoxaparin course and 5% achieved values of supratherapeutic anticoagulation (anti-Xa level >1 units/mL). Serum anti-Xa level did not correlate with once versus twice daily dosing, body mass index (BMI), or creatinine level. Blood urea nitrogen (BUN) was found to have a positive odds ratio for an anti-Xa level ≥ 0.5 units/mL. We believe that this incidence of unintended therapeutic anticoagulation indicates a clinically significant number and therefore routine anti-Xa evaluation while on VTE prophylaxis is warranted within our population.
(Published by Elsevier Ltd.)
Databáze: MEDLINE
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