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

Amanda M. Marshall, Taylor M. Trussell, Addison M. Yee, Mathew P. Malone

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)117-120
Number of pages4
JournalThrombosis Research
Volume203
DOIs
StatePublished - Jul 2021

Keywords

  • Anticoagulants
  • Blood coagulation
  • Coagulation factor Xa
  • Deep venothromboembolism prophylaxis
  • Enoxaparin
  • Hemorrhage

ASJC Scopus subject areas

  • Hematology

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