Feasibility and safety of enoxaparin whole milligram dosing in premature and term neonates

Goldsmith, Richard W.; Chan, Anthony; Paes, Bosco; Bhatt, Mihir

doi:10.1038/jp.2015.84

Cited by 10 publications

(10 citation statements)

References 24 publications

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“…For anticoagulation, unfractionated heparin is useful as initial therapy, especially if the infant is unstable or surgery is anticipated . Overall, LMWH is preferable in neonates because of its established pharmacokinetics and ease of administration subcutaneously . Extensive PVT may require initial thrombolysis followed by LMWH, and tissue plasminogen activator is currently being used preferentially over urokinase.…”

Section: Discussionmentioning

confidence: 99%

“…38 Overall, LMWH is preferable in neonates because of its established pharmacokinetics and ease of administration subcutaneously. [38][39][40] Extensive PVT may require initial thrombolysis followed by LMWH, and tissue plasminogen activator is currently being used preferentially over urokinase. However, it is expensive, and increased clot lysis by r-tPA has not been demonstrated in clinical trials in neonates.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Bhatt

Patel

Butt

et al. 2018

Pediatric Blood & Cancer

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Background Neonatal portal vein thrombosis (PVT) is uncommon with potentially serious complications that may manifest in infancy and childhood. Objective The primary aim of our study was to describe the short‐term and long‐term outcomes of neonatal PVT. Methods A retrospective chart review was conducted from 2008 to 2016 of neonates diagnosed with PVT. A systematic review was also performed from 2000 to 2018 to evaluate anticoagulant therapy (ACT) in neonatal PVT. Results Forty‐four premature and 30 term infants (mean gestational age 30.7 vs 39.1 weeks, respectively) had PVT. Sixty‐eight involved the left portal vein, one involved only the main portal vein, and 5 involved ≥1 vein. PVT was catheter associated in 46 (62%); none of the 7 neonates tested had thrombophilia. Of 74 neonates, 19 (26%) received ACT and 55 (74%) were untreated. The mean follow‐up duration was 16.6 months (SD = 17.62; range, 0–89.6); 59.5% were followed for ≥6 months. On last ultrasound examination, thrombus resolution was documented in treated (ACT; n = 19) and nontreated (n = 55) neonates: 12 (63%) versus 32 (58%) with complete resolution, 1 (5%) versus 6 (11%) partial, 0 versus 1 (2%) extension, and 6 (32%) versus 16 (29%) had nonprogressive lesions, respectively. Seventy‐one (96%) had no complications. Seventy‐one articles met inclusion criteria for the systematic review and 19 were retained for analysis after assessment. Conclusions PVT resolution rate was similar to previous reports. Although a low complication rate was detected, longer follow‐up is necessary to determine the need for early treatment and the precise incidence of outcomes such as portal hypertension.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Bhatt

Patel

Butt

et al. 2018

Pediatric Blood & Cancer

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“…Low-molecular-weight heparin has fewer monitoring requirements than ordinary heparin, is a simple operation, has a lower risk of bleeding and is often used as an anticoagulant treatment. Goldsmith et al[ 18 ] reported low use in the literature. The effectiveness of molecular heparin sodium in the treatment of thrombosis in preterm infants[ 18 ] and reports in the literature indicate that the use of low-molecular-heparin calcium can successfully treat children with thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Goldsmith et al[ 18 ] reported low use in the literature. The effectiveness of molecular heparin sodium in the treatment of thrombosis in preterm infants[ 18 ] and reports in the literature indicate that the use of low-molecular-heparin calcium can successfully treat children with thrombosis. In this case, it is considered that low-molecular-heparin calcium can cause subcutaneous nodules due to calcium salt deposition; thus, Kesai was selected as the therapeutic drug.…”

Section: Discussionmentioning

confidence: 99%

Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review

Huang

Wan

et al. 2020

WJCC

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BACKGROUND Extremely premature infants have poor vascular conditions. Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters, and these vessels are often accompanied by arteries; thus, it is easy to mistakenly enter the artery. CASE SUMMARY The case of an extremely premature infant (born at gestational age 28 +3 ) in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported. On the 19 th day of hospitalization, the index finger, middle finger and ring finger of the left hand were rosy, the left radial artery and brachial artery pulse were palpable, the recovery was 95%, and the improvement was obvious. At discharge 42 d after admission, there was no abnormality in fingertip activity during the follow-up period. CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2% nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb. Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.

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“…Infants were less likely to achieve a therapeutic anti‐FXa level on their first monitoring test , were more likely to require multiple dose escalations , and took more days of therapy to achieve a therapeutic anti‐FXa level . Several studies confirmed different mean dose requirements for neonates and infants, with neonates requiring between 1.62 mg kg −1 and 2 mg kg −1 twice daily, as compared with infants’ requirements of 1.12–1.9 mg kg −1 twice daily , both of which are greater than the recommended starting doses of 1 mg kg −1 for children and 1.5 mg kg −1 for neonates and infants up to 2 months of age . Compounding this age‐related difference in dose requirements is the known assay‐dependent variability reported by Greene et al .…”

Section: Anticoagulant Therapy: Which Agent Intensity and Duration?mentioning

confidence: 99%

Anticoagulant prophylaxis and therapy in children: current challenges and emerging issues

Newall

Branchford

Male

2018

Journal of Thrombosis and Haemostasis

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This review is aimed at describing the unique challenges of anticoagulant prophylaxis and treatment in children, and highlighting areas for research for improving clinical outcomes of children with thromboembolic disease. The evidence presented demonstrates the challenges of advancing the evidence base informing optimal management of thromboembolic disease in children. Recent observational studies have identified risk factors for venous thromboembolism in children, but there are few interventional studies assessing the benefit-risk balance of using thromboprophylaxis in risk-stratified clinical subgroups. A risk level-based framework is proposed for administering mechanical and pharmacological thromboprophylaxis. More research is required to refine the assignment of risk levels. The anticoagulants currently used predominantly in children are unfractionated heparin, low molecular weight heparin, and vitamin K antagonists. There is a paucity of robust evidence on the age-specific pharmacology of these agents, and their efficacy and safety for prevention and treatment of thrombosis in children. The available literature is heterogeneous, reflecting age-specific differences, and the various clinical settings for anticoagulation in children. Monitoring assays and target ranges are not well established. Nevertheless, weight-based dosing appears to achieve acceptable outcomes in most indications. Given the limitations of the classical anticoagulants for children, there is great interest in the direct oral anticoagulants (DOACs), whose properties appear to be particularly suitable for children. All DOACs currently approved for adults have Pediatric Investigation Plans ongoing or planned. These are generating age-specific formulations and systematic dosing information. The ongoing pediatric studies still have to establish whether DOACs have a positive benefit-risk balance in the various pediatric indications and age groups.

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Feasibility and safety of enoxaparin whole milligram dosing in premature and term neonates

Abstract: Whole milligram dosing of enoxaparin for thrombosis is feasible, safe and effective in premature and term neonates.

Cited by 10 publications

References 24 publications

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Outcomes following neonatal portal vein thrombosis: A descriptive, single‐center study and review of anticoagulant therapy

Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review

Anticoagulant prophylaxis and therapy in children: current challenges and emerging issues

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