Israel Emily N, Thomas Christopher A, Mastropietro Christopher W
1Department of Pharmacy,Riley Hospital for Children at Indiana University Health,Indianapolis,IN,USA.
3Section of Pediatric Cardiac Intensive Care,Riley Hospital for Children at Indiana University Health,Indianapolis,IN,USA.
Cardiol Young. 2018 May;28(5):715-718. doi: 10.1017/S1047951118000173. Epub 2018 Mar 1.
Enoxaparin may be used to prevent central venous catheter-related thrombosis in patients with CHD. We aimed to determine whether current enoxaparin dosing regimens effectively achieve anti-factor Xa concentrations within prophylactic goal ranges in this patient population.
We implemented a formal protocol aimed at reducing central venous catheter-related thrombosis in children with CHD in January, 2016. Standard empiric prophylactic enoxaparin dosing regimens were used - for example, 0.75 mg/kg/dose every 12 hours for patients <2 months of age and 0.5 mg/kg/dose every 12 hours for patients ⩾2 months of age - with anti-factor Xa goal range of 0.25-0.49 IU/ml. Patients <2 years of age who received enoxaparin and had at least one valid steady-state anti-factor Xa measurement between 25 January, 2016 and 31 August, 2016 were retrospectively reviewed.
During the study period, 47 patients had 186 anti-factor Xa concentrations measured, of which 20 (11%) were above and 112 (60%) were below the prophylactic goal range. Anti-factor Xa concentrations within the goal range were ultimately achieved in 31 patients. Median dose required to achieve anti-factor Xa concentrations within the prophylactic range was 0.89 mg/kg/dose (25, 75%: 0.75, 1.11) for patients <2 months (n=23 patients) and 0.79 mg/kg/dose (25, 75%: 0.62, 1.11) for patients ⩾2 months (n=8 patients).
Enoxaparin doses required to achieve prophylactic anti-factor Xa concentrations in young children with CHD were consistently higher than the currently recommended prophylactic dosing regimens. Further study is needed to determine whether dose titration to achieve prophylactic anti-factor Xa concentrations is effective in preventing central venous catheter-related thrombosis.
依诺肝素可用于预防冠心病患者中心静脉导管相关血栓形成。我们旨在确定当前依诺肝素给药方案是否能在该患者群体中有效达到预防目标范围内的抗Xa因子浓度。
我们于2016年1月实施了一项旨在减少冠心病患儿中心静脉导管相关血栓形成的正式方案。采用标准经验性预防性依诺肝素给药方案，例如，2个月龄以下患者每12小时0.75mg/kg/剂量，2个月龄及以上患者每12小时0.5mg/kg/剂量，抗Xa因子目标范围为0.25 - 0.49IU/ml。对2016年1月25日至2016年8月31日期间接受依诺肝素治疗且至少有一次有效稳态抗Xa因子测量值的2岁以下患者进行回顾性分析。
在研究期间，47例患者共测量了186次抗Xa因子浓度，其中20次（11%）高于预防目标范围，112次（60%）低于预防目标范围。最终31例患者的抗Xa因子浓度达到目标范围。2个月龄以下患者（n = 23例）达到预防范围内抗Xa因子浓度所需的中位剂量为0.89mg/kg/剂量（25%，75%：0.75，1.11），2个月龄及以上患者（n = 8例）为0.79mg/kg/剂量（25%，75%：0.62，1.11）。
冠心病幼儿达到预防性抗Xa因子浓度所需的依诺肝素剂量始终高于目前推荐的预防性给药方案。需要进一步研究以确定通过剂量滴定达到预防性抗Xa因子浓度是否能有效预防中心静脉导管相关血栓形成。
