Key result
Enoxaparin dose adjustment using the CHEST guidelines nomogram in pediatric patients resulted in therapeutic anti-Xa levels in only 29.2% to 62% of patients depending on the initial level.
Why the study?
To evaluate the CHEST-recommended standardized dosage adjustment nomogram for enoxaparin in hospitalized pediatric patients and evaluate the necessity of routine, repeated anti-factor Xa monitoring.
Does the CHEST guideline enoxaparin dose adjustment nomogram reliably achieve therapeutic anti-Xa levels in hospitalized pediatric patients?
Cohort (n=467)
No
Does the CHEST guideline enoxaparin dose adjustment nomogram reliably achieve therapeutic anti-Xa levels in hospitalized pediatric patients?
The standardized CHEST dosage adjustment nomogram for enoxaparin in pediatric patients is unreliable for achieving therapeutic anti-Xa levels, suggesting a need for revised dosing strategies.
CHEST nomogram may yield inconsistent anti-Xa levels in children; hypothesis-generating for revised pediatric dosing in prospective trials.
OBJECTIVES: The purposes of this study are to perform a large-scale evaluation of the standardized dosage adjustment nomogram recommended by the American College of Chest Physicians (CHEST) for the management of enoxaparin in hospitalized pediatric patients and to determine the necessity of routine and repeated anti-factor Xa (anti-Xa) levels. METHODS: A retrospective cohort study was designed, and charts were reviewed in a single tertiary care institution for all patients who received enoxaparin between October 1, 2010, through September 30, 2016. Patients were included if they were receiving treatment doses of enoxaparin according to the pediatric CHEST guidelines, had a subtherapeutic or supratherapeutic anti-Xa level drawn at 3.5 to 6 hours after a dose, had a dose changed in an attempt to attain a therapeutic anti-Xa level, and had a second anti-Xa level drawn 3.5 to 6 hours after the dose change. Descriptive statistical methods were used to characterize the ability of dose adjustment via a nomogram to attain an anti-Xa of 0.5 to 1 unit/mL. RESULTS: A total of 467 patients were identified who received the appropriate initial dose and dosage adjustment and whose levels were drawn according to the CHEST guidelines. In patients who had an initial anti-Xa level of <0.35 units/mL and received the nomogram recommended dose increase of 25% ± 5%, 28 out of 96 patients (29.2%) reached therapeutic levels. Of 197 patients who had an initial anti-Xa level between 0.35 and 0.49 units/mL and who received the nomogram recommended dose increase of 10% ± 5%, 116 (58.9%) reached therapeutic levels. Of 50 patients with an initial anti-Xa level between 1.1 and 1.5 units/mL and who received the nomogram dose decrease of 20% ± 5%, 31 (62%) reached therapeutic levels. CONCLUSIONS: The current dosage adjustment nomogram recommended by the CHEST guidelines does not reliably lead to therapeutic anti-Xa levels when used to adjust enoxaparin doses in pediatric patients.
No takes yet. Share an insight, caveat, or question.
Dinh et al. (2019) conducted a cohort in Hospitalized pediatric patients requiring enoxaparin (n=467). Enoxaparin dose adjustment via CHEST guidelines nomogram was evaluated on Attainment of therapeutic anti-Xa level (0.5 to 1 unit/mL). Enoxaparin dose adjustment using the CHEST guidelines nomogram in pediatric patients resulted in therapeutic anti-Xa levels in only 29.2% to 62% of patients depending on the initial level.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: