Diab Yaser A, Ramakrishnan Karthik, Ferrell Brandon, Chounoune Reginald, Alfares Fahad A, Endicott Kendal M, Rooney Sara, Corcoran Jason, Zurakowski David, Berger John T, Shankar Venkat, Nath Dilip S
All authors: Children's National Health System, Washington, DC.
Pediatr Crit Care Med. 2017 May;18(5):e207-e214. doi: 10.1097/PCC.0000000000001126.
Subcutaneous enoxaparin is the mainstay anticoagulant in critically ill pediatric patients although it poses several challenges in this patient population. Enoxaparin infused IV over 30 minutes represents an attractive alternative, but there is limited experience with this route of administration in children. In this study, we assess dosing, anticoagulation quality, safety, and clinical efficacy of IV enoxaparin compared to subcutaneous enoxaparin in critically ill infants and children.
Retrospective single-center study comparing dosing, anticoagulation quality, safety, and clinical efficacy of two different routes of enoxaparin administration (IV vs subcutaneous) in critically ill infants and children. Key outcome measures included dose needed to achieve target antifactor Xa levels, time required to achieve target antifactor Xa levels, proportion of patients achieving target anticoagulation levels on initial dosing, number of dose adjustments, duration spent in the target antifactor Xa range, anticoagulation-related bleeding complications, anticoagulation failure, and radiologic response to anticoagulation.
Tertiary care pediatric hospital.
All children admitted to the cardiac ICU, PICU, or neonatal ICU who were prescribed enoxaparin between January 2014 and March 2016 were studied.
One hundred ten patients were identified who had received IV or subcutaneous enoxaparin and had at least one postadministration peak antifactor Xa level documented.
Of the 139 courses of enoxaparin administered, 96 were therapeutic dose courses (40 IV and 56 subcutaneous) and 43 were prophylactic dose courses (20 IV and 23 subcutaneous). Dosing, anticoagulation quality measurements, safety, and clinical efficacy were not significantly different between the two groups.
Our study suggests that anticoagulation with IV enoxaparin infused over 30 minutes is a safe and an equally effective alternative to subcutaneous enoxaparin in critically ill infants and children.
皮下注射依诺肝素是危重症儿科患者的主要抗凝药物，尽管在这一患者群体中它存在一些挑战。静脉输注依诺肝素30分钟是一种有吸引力的替代方法，但儿童中这种给药途径的经验有限。在本研究中，我们评估了静脉注射依诺肝素与皮下注射依诺肝素相比，在危重症婴幼儿和儿童中的给药剂量、抗凝质量、安全性和临床疗效。
回顾性单中心研究，比较两种不同依诺肝素给药途径（静脉注射与皮下注射）在危重症婴幼儿和儿童中的给药剂量、抗凝质量、安全性和临床疗效。主要结局指标包括达到目标抗Xa因子水平所需的剂量、达到目标抗Xa因子水平所需的时间、初始给药时达到目标抗凝水平的患者比例、剂量调整次数、在目标抗Xa因子范围内的持续时间、抗凝相关出血并发症、抗凝失败以及抗凝的放射学反应。
三级儿科医院。
研究了2014年1月至2016年3月期间入住心脏重症监护病房、儿科重症监护病房或新生儿重症监护病房并开具依诺肝素处方的所有儿童。
确定了接受静脉或皮下依诺肝素治疗且至少有一次给药后抗Xa因子峰值水平记录的110名患者。
在139例依诺肝素给药疗程中（96例为治疗剂量疗程，40例静脉注射和56例皮下注射；43例为预防剂量疗程，20例静脉注射和23例皮下注射），两组在给药剂量、抗凝质量测量、安全性和临床疗效方面无显著差异。
我们的研究表明，在危重症婴幼儿和儿童中，30分钟静脉输注依诺肝素抗凝是皮下注射依诺肝素的一种安全且同样有效的替代方法。
