PMID- 10779027 OWN - NLM STAT- MEDLINE DCOM- 20000503 LR - 20190915 IS - 1077-4114 (Print) IS - 1077-4114 (Linking) VI - 22 IP - 2 DP - 2000 Mar-Apr TI - Low-molecular-weight heparin in thrombotic disease in children and adolescents. PG - 137-42 AB - PURPOSE: The use of unfractionated heparin (UFH) in children is problematic. In adults, subcutaneous low-molecular-weight heparin (LMWH) is as effective as UFH in the treatment of thrombosis. Because pediatric data are limited, the authors studied the use of enoxaparin in children. PATIENTS AND METHODS: Nineteen children (ages 18 days to 19 years; median age, 40 months) with indications for thrombosis treatment or prophylaxis were studied. Six patients (median age, 33 months), treated on a protocol that included pharmacokinetic studies, initially received enoxaparin 1 mg/kg subcutaneously every 12 hours; doses then were adjusted until target plasma levels of 0.5 to 1.2 anti-Xa U/mL were achieved. The records of 13 additional patients treated with enoxaparin off study were reviewed. RESULTS: In the first six patients, enoxaparin pharmacokinetics was found to be similar to that in adults; once targeted levels were achieved, these remained stable. Among all 19 subjects, 14 had treatment of active thrombosis and 5 underwent thrombosis prophylaxis. For treatment of thrombosis, enoxaparin 1 mg/kg initially was administered subcutaneously every 12 hours. Target anti-Xa levels were achieved with 0.55 to 1.5 mg/kg every 12 hours (mean, 0.98 mg/kg; median, 1.0 mg/kg) in 1 to 7 days (median, 1 day). All patients in the treatment group had clinical improvement within 2 to 5 days, and 12 had follow-up radiological studies that confirmed this. For prophylaxis, enoxaparin was given at 1 mg/kg subcutaneously every 24 hours. No new thrombi were clinically evident in this group. There was no major bleeding with enoxaparin; one patient had transient mild mucosal oozing. CONCLUSION: In this limited population, enoxaparin seems to be a safe, effective, and convenient alternative to UFH in children and adolescents. The adult therapeutic target range of 0.5 to 1.2 anti-Xa U/mL is readily achievable with a starting dose of 1 mg/kg every 12 hours in most children. Initial close monitoring with plasma anti-Xa activity should be done and doses adjusted to achieve target range, particularly in neonates. In the population of this study, enoxaparin seems as effective as UFH in the period immediately thrombotic episode. These results should be confirmed in the ongoing randomized trial comparing LMWH with UFH in children. FAU - Punzalan, R C AU - Punzalan RC AD - Department of Pediatrics, Medical College of Wisconsin, and Children's Hospital of Wisconsin, Milwaukee, USA. FAU - Hillery, C A AU - Hillery CA FAU - Montgomery, R R AU - Montgomery RR FAU - Scott, C A AU - Scott CA FAU - Gill, J C AU - Gill JC LA - eng GR - 5M01RR00058/RR/NCRR NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - J Pediatr Hematol Oncol JT - Journal of pediatric hematology/oncology JID - 9505928 RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) SB - IM CIN - J Pediatr Hematol Oncol. 2000 Mar-Apr;22(2):98-9. PMID: 10779020 MH - Adolescent MH - Adult MH - Anticoagulants/adverse effects/pharmacokinetics/*therapeutic use MH - Child MH - Child, Preschool MH - Enoxaparin/adverse effects/pharmacokinetics/*therapeutic use MH - Humans MH - Infant MH - Thrombosis/*drug therapy/metabolism/prevention & control MH - Treatment Outcome EDAT- 2000/04/25 00:00 MHDA- 2000/04/25 00:01 CRDT- 2000/04/25 00:00 PHST- 2000/04/25 00:00 [pubmed] PHST- 2000/04/25 00:01 [medline] PHST- 2000/04/25 00:00 [entrez] AID - 10.1097/00043426-200003000-00011 [doi] PST - ppublish SO - J Pediatr Hematol Oncol. 2000 Mar-Apr;22(2):137-42. doi: 10.1097/00043426-200003000-00011.