Andrade-Campos Marcio M, Montes-Limón Anel E, Fernandez-Mosteirin Nuria, Salvador-Osuna Carlos, Torres Manuel, Lucia-Cuesta Jose F, Rubio-Felix Daniel
Section of Haemostasis, Department of Haematology and Hemotherapy, Miguel Servet University Hospital, Zaragoza, Spain.
Blood Coagul Fibrinolysis. 2013 Mar;24(2):194-8. doi: 10.1097/MBC.0b013e32835b72b8.
Pediatric deep vein thrombosis (DVT) is an emerging problem in tertiary care hospitals, recent reviews shows a rate of 40.2/10,000 admissions. Experts affirm that enoxaparin has become in the drug of choice for DVT therapy. Despite this, there is a little information regarding the optimal dose schedule for enoxaparin therapy in children and the therapeutic guidelines for enoxaparin use in children are extrapolated from adult guidelines. Monitoring by antifactor Xa (anti-Xa) measurement and target concentrations between 0.5-1 U/ml at 4-6 h postdose are recommended. This study was designed to analyse our experience in paediatric-specific dosage requirements for enoxaparin therapy. A retrospective study was performed with patients less than 16 years old, who were treated with enoxaparin for DVT and monitored by anti-Xa concentration, between January 2005 and March 2012. Demographic and clinical characteristics and outcomes were obtained. Fourteen patients were analyzed: boy/girl ratio, 8/4; median age, 3.5 months. Cerebral venous sinus thrombosis was the most common indication for therapy. All patients presented thrombosis risks factors. Dose increases were necessary only in patients less than 6 years old. Target anti-Xa concentrations were achieved in 12 (85%) patients. Children younger than 1 year required a higher dose of enoxaparin/kg (1.5-2.7 mg/kg per 12 h). Complete resolutions of DVT were registered in all cases. The mean number of dose increases was three and a median of 11 days to achieve target anti-Xa concentration. This study indicates that an initial higher enoxaparin dose may be necessary in neonates and infants, but other factors must be considered to improve management.
小儿深静脉血栓形成（DVT）在三级护理医院中是一个新出现的问题，最近的综述显示其发生率为40.2/10000例入院病例。专家们确认依诺肝素已成为DVT治疗的首选药物。尽管如此，关于儿童依诺肝素治疗的最佳剂量方案的信息很少，儿童依诺肝素使用的治疗指南是从成人指南推断而来的。建议通过抗Xa因子（抗Xa）测量进行监测，给药后4 - 6小时的目标浓度为0.5 - 1 U/ml。本研究旨在分析我们在儿童依诺肝素治疗特定剂量需求方面的经验。对2005年1月至2012年3月期间年龄小于16岁、接受依诺肝素治疗DVT并通过抗Xa浓度监测的患者进行了一项回顾性研究。获取了人口统计学和临床特征及结果。分析了14例患者：男女比例为8/4；中位年龄为3.5个月。脑静脉窦血栓形成是最常见的治疗指征。所有患者均存在血栓形成危险因素。仅6岁以下患者需要增加剂量。12例（85%）患者达到了目标抗Xa浓度。1岁以下儿童每千克体重需要更高剂量的依诺肝素（每12小时1.5 - 2.7 mg/kg）。所有病例的DVT均完全消退。达到目标抗Xa浓度的平均增加剂量次数为3次，中位时间为11天。本研究表明，新生儿和婴儿可能需要初始较高剂量的依诺肝素，但必须考虑其他因素以改善管理。
