Why the study?
Low-molecular-weight heparin is cleared through the kidneys and commonly used for anticoagulation in pediatric patients, creating management challenges in renal dysfunction.
How should low-molecular-weight heparin dosing and monitoring be managed in pediatric patients with thromboembolism and renal dysfunction?
How should low-molecular-weight heparin dosing and monitoring be managed in pediatric patients with thromboembolism and renal dysfunction?
Close monitoring of anti-Xa levels and dose adjustments of low-molecular-weight heparin are necessary in pediatric patients with thromboembolism and varying states of renal dysfunction.
Anti-Xa fluctuations in pediatric LMWH use warrant renal assessment; leaves open prospective validation of monitoring protocols.
BACKGROUND: Low-molecular-weight heparin is cleared through the kidneys and is commonly used for anticoagulation in the pediatric population. OBSERVATION: We present 3 challenging cases of children requiring anticoagulation in the context of acute kidney injury, nephrotic syndrome, and hemodialysis. CONCLUSIONS: A significant change in anti-factor Xa (anti-Xa) levels-used for drug monitoring-should prompt an assessment of renal function. In nephrotic syndrome, anti-Xa levels should be closely monitored when there is a change in the status of nephrotic disease activity. In hemodialysis patients, enoxaparin at once daily reduced dosing should be considered with trough and peak anti-Xa levels monitoring.
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Bahabri et al. (2020) studied this question.
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