Abstract Introduction: Venous thromboembolism prevalence amongst paediatric patients with CHD has increased over the years. Enoxaparin’s favourable pharmacokinetic and pharmacodynamic properties, paired with less intensive monitoring parameters, make it a desirable treatment option. Currently, reported enoxaparin dosing strategies and their correlation to therapeutic anti-Xa levels are variable for infants aged 2 to 12 months. Methods: This retrospective chart review evaluated the percentage of patients who achieved initial target anti-Xa levels on therapeutic enoxaparin. Patients were divided into standard-dose enoxaparin of 1 mg/kg every 12 hours and high-dose enoxaparin of 1.5 mg/kg every 12 hours. Results: Eighty-five patients were included in this study with similar demographics. More patients in the high-dose group achieved initial therapeutic levels of enoxaparin (36 (69%) vs 5 (15%); p < 0.001). The time between initial dose of enoxaparin and first therapeutic anti-Xa level was longer in the standard-dose group (87 hrs (IQR 41 to 112) vs 24 hrs (IQR 16 to 40; p < 0.001)), and there was no difference in the incidence of minor bleeding (6 (18%) vs 4 (7.7%); p = 0.18) or major bleeding (1 (3%) vs 0 (0%); p = 0.39), respectively. Conclusions: High-dose enoxaparin in infants with CHD resulted in a higher percentage of initial anti-Xa target attainment and a decreased time to target anti-Xa level, with no difference in bleeding. Our study suggests it may be safe and effective to dose enoxaparin higher in infants with CHD; however, further studies should confirm these findings.
Price et al. (Fri,) studied this question.