Bauman M E, Black K L, Bauman M L, Belletrutti Mark, Bajzar L, Massicotte M P
Stollery Children's Hospital, University of Alberta, Edmonton, AB.
Thromb Res. 2009 Apr;123(6):845-7. doi: 10.1016/j.thromres.2008.09.001. Epub 2008 Nov 26.
Enoxaparin is a low molecular weight heparin (LMWH) commonly used for thromboprophylaxis children. Enoxaparin dosing is based on patients' weight and results in decimal dosing. Due to the high concentration of enoxaparin the resultant decimal dose makes precise measurement difficult. Dilution is necessary and often results in ten-fold medication administration errors [Ghaleb MA, Barber N, Franklin BD, Yeung VWS, Khaki ZF, Wong ICK. Systematic review of medication errors in pediatric patients. Ann Pharmacother Oct 2006;40(10):1766-76, Raju TN, Kecskes S, Thornton JP, Perry M, Feldman S. Medication errors in neonatal and paediatric intensive-care units. Lancet Aug 12 1989;2(8659):374-6]. Enoxaparin may be administered in whole milligram doses via insulin syringe, where one milligram of enoxaparin equals one unit on the 100 unit graduated insulin syringe.
A retrospective chart review of 514 children. Data was collected on underlying diagnosis, reason for anticoagulation, anti-Xa levels, hemorrhagic events, and medication errors identified.
to determine the occurrence rate of supra-therapeutic anticoagulation as indicated by anti-Xa levels >1.0 u/ml, when enoxaparin doses are rounded up to the whole milligram, and are administered using insulin syringes. The secondary objectives were to determine if the supra-therapeutic anti-Xa levels were associated with hemorrhagic events. To determine if children achieved and maintained therapeutic anti-Xa range using whole milligram dosing and to evaluate the impact of utilizing insulin syringes for administration on reducing dose measurement errors.
All 514 patients were prescribed whole milligram enoxaparin dosing, and achieved therapeutic anti-Xa within a mean time of 2 days. No infant or child required decimal doses to achieve therapeutic levels. Five children achieved an initial supra-therapeutic anti-Xa level (1.04 -1.36 U/ml), requiring a single whole milligram dose decrease. There were no associated hemorrhagic events.
Whole milligram enoxaparin dosing administered via an insulin syringe safely and effectively, achieved therapeutic levels in infants and children. The reduced incidence of enoxaparin dosing errors suggests that whole milligram enoxaparin dosing via an insulin syringe is a method that should be considered for standard of care.
依诺肝素是一种常用于儿童血栓预防的低分子量肝素（LMWH）。依诺肝素的剂量基于患者体重，会产生小数剂量。由于依诺肝素浓度高，所得的小数剂量难以精确测量。稀释是必要的，但这常常导致十倍的用药错误[Ghaleb MA，Barber N，Franklin BD，Yeung VWS，Khaki ZF，Wong ICK。儿科患者用药错误的系统评价。《药物治疗学》2006年10月；40(10):1766 - 1776，Raju TN，Kecskes S，Thornton JP，Perry M，Feldman S。新生儿和儿科重症监护病房的用药错误。《柳叶刀》1989年8月12日；2(8659):374 - 376]。依诺肝素可以通过胰岛素注射器以整毫克剂量给药，其中1毫克依诺肝素相当于100单位刻度胰岛素注射器上的1个单位。
对514名儿童进行回顾性病历审查。收集了关于潜在诊断、抗凝原因、抗Xa水平、出血事件和识别出的用药错误的数据。
确定当依诺肝素剂量向上取整至整毫克并使用胰岛素注射器给药时，抗Xa水平>1.0 U/ml所表明的超治疗性抗凝的发生率。次要目标是确定超治疗性抗Xa水平是否与出血事件相关。确定儿童使用整毫克剂量是否达到并维持治疗性抗Xa范围，并评估使用胰岛素注射器给药对减少剂量测量错误的影响。
所有514例患者均被处方依诺肝素整毫克剂量，并在平均2天内达到治疗性抗Xa水平。没有婴儿或儿童需要小数剂量来达到治疗水平。5名儿童达到初始超治疗性抗Xa水平（1.04 - 1.36 U/ml），需要单次减少1个整毫克剂量。没有相关的出血事件。
通过胰岛素注射器给予依诺肝素整毫克剂量安全有效，在婴儿和儿童中达到了治疗水平。依诺肝素给药错误发生率的降低表明，通过胰岛素注射器给予依诺肝素整毫克剂量是一种应被考虑作为护理标准的方法。
