Association of outcomes and anti‐Xa levels in the treatment of pediatric venous thromboembolism

Fan, Jennifer L; Roberts, Laura; Scheurer, Michael E.; Yee, Donald L.; Shah, Mona D.; Lee-Kim, Young Na J.

doi:10.1002/pbc.26629

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…This would suggest that the clinically effective concentration may be lower than the purported therapeutic guidelines. 32 This confirms the findings in several case reports and single-center studies, 4,33 which found recommended dosing of 1.5 mg/kg/dose every 12 hours to be inadequate to achieve desired therapeutic response. The dosage for our patient began at 2 mg/ kg every 12 hours and was increased to a high of 3.49 mg/kg every 12 hours.…”

Section: Discussionsupporting

confidence: 86%

Methicillin-Resistant Staphylococcus aureus Endovascular Infection in a Neonate: Prolonged, Safe, and Effective Use of Daptomycin and Enoxaparin

Chan¹,

Noor²,

Clauss³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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We report on a former 28-week gestation neonate with persistent methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, with a heterozygous Factor V Leiden mutation. The neonate became clinically ill after 1 week of life, with positive blood cultures for MRSA. Echocardiography revealed large thrombi in the inferior vena cava and right atrium. Bacteremia persisted despite removal of umbilical arterial and venous catheters and empiric administration of therapeutic doses of vancomycin (minimum inhibitory concentration [MIC] 2 mg/L) and ceftazidime. To narrow therapy, ceftazidime was discontinued, while gentamicin and rifampin were added. Cultures remained positive and, therefore, linezolid was added, and subsequent blood cultures became negative. Since prolonged linezolid use of 2 weeks or longer carries potential adverse effects, antibiotics were changed to daptomycin, which is bactericidal and recommended for treatment of invasive MRSA infections when vancomycin MICs are ≥2 mg/L to minimize vancomycin treatment failure. Enoxaparin was initiated, with anti-Xa assay monitoring. A workup for thrombophilia revealed heterozygous Factor V Leiden mutation. Serial echocardiograms demonstrated decreasing size of the thrombi, which were no longer visualized at 2 months of age. Creatinine kinase remained normal. The infant had no seizures on daptomycin. The management of persistent MRSA bacteremia in neonates associated with a large thrombus poses a unique challenge due to the long duration of treatment. To our knowledge, this is the first case of prolonged and safe daptomycin and enoxaparin use in a preterm neonate. Daptomycin may be considered in cases of clinical failure with vancomycin when a lengthy treatment course is contemplated.

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Section: Discussionsupporting

confidence: 86%

Methicillin-Resistant Staphylococcus aureus Endovascular Infection in a Neonate: Prolonged, Safe, and Effective Use of Daptomycin and Enoxaparin

Chan¹,

Noor²,

Clauss³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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“…In all cases, resolution/recurrence rate was more positive than TTR achievement rate. 29,[32][33][34][35][36] Further, there was no association between anti-factor Xa level and bleeding.…”

Section: Lmwhmentioning

confidence: 99%

“…The optimal scheduling of anti-factor Xa assays in children receiving LMWH has received surprisingly little attention, with no article clearly outlining a preferred schedule. 29,32,34 It appears that many studies have performed monitoring of anti-factor Xa assays daily or twice daily until the LMWH is therapeutic and then weekly thereafter with reducing frequency if the patient remained therapeutic or stable and in the absence of renal impairment. The practicalities of being able to draw blood often further reduce the frequency of monitoring.…”

Section: Lmwhmentioning

confidence: 99%

Management of thrombosis in children and neonates: practical use of anticoagulants in children

Monagle

Newall

2018

Hematology

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Venous thrombosis (VTE) in children and neonates presents numerous management challenges. Although increasing in frequency, VTE in children and neonates is still uncommon compared with adults. The epidemiology of VTE is vastly different in neonates vs children vs adolescents vs adults. In reality, pediatric thrombosis should be viewed as a multitude of rare diseases (eg, renal vein thrombosis, spontaneous thrombosis, catheter-related thrombosis, cerebral sinovenous thrombosis), all requiring different approaches to diagnosis and with different short- and long-term consequences, but linked by the use of common therapeutic agents. Further, children have fundamentally different physiology in terms of blood flow, developmental hemostasis, and, likely, endothelial function. The American Society ofHematology 2017 Guidelines for Management of Venous Thromboembolism: Treatment of Pediatric VTE provides up-to-date evidence-based guidelines related to treatment. Therefore, this article will focus on the practical use of therapeutic agents in the management of pediatric VTE, especially unfractionated heparin, low-molecular-weight heparin, and oral vitamin K antagonists, as the most common anticoagulants used in children. Direct oral anticoagulants (DOACs) remain in clinical trials in children and should not be used outside of formal trials for the foreseeable future.

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Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

et al. 2021

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Association of outcomes and anti‐Xa levels in the treatment of pediatric venous thromboembolism

Abstract: There was no statistically significant difference between low-range versus high-range mean anti-Xa levels and thrombus resolution. Empiric clinical practices of targeting anti-Xa levels in the higher therapeutic range to achieve better outcomes may not be warranted.

Cited by 4 publications

References 23 publications

Methicillin-Resistant Staphylococcus aureus Endovascular Infection in a Neonate: Prolonged, Safe, and Effective Use of Daptomycin and Enoxaparin

Methicillin-Resistant Staphylococcus aureus Endovascular Infection in a Neonate: Prolonged, Safe, and Effective Use of Daptomycin and Enoxaparin

Management of thrombosis in children and neonates: practical use of anticoagulants in children

Risk factors determining central venous access device-associated deep vein thrombosis resolution in children: a retrospective study

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