Low-molecular-weight heparin in pediatric patients with thrombotic disease: A dose finding study

Massicotte, Patti; Adams, Margaret; Marzinotto, Velma; Brooker, Lu Ann; Andrew, Maureen

doi:10.1016/s0022-3476(96)70273-1

Cited by 253 publications

(198 citation statements)

References 45 publications

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“…Previous studies in infants and children have demonstrated that doses of enoxaparin to achieve adult therapeutic anti-FXa levels of 0.5-1.0 U/m are age dependent, with preterms and newborns having increased requirements compared with older infants and children [12][13][14][20][21][22][23]. Possible explanations for the increased requirements of LMWH in newborns include a faster clearance of LMWH due to a larger volume of distribution, and decreased plasma concentrations of antithrombin in newborns compared with older children [10].…”

Section: Discussionmentioning

confidence: 99%

Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

et al. 2007

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Section: Discussionmentioning

confidence: 99%

Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

et al. 2007

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“…≥2 mo=1.0 mg/kg per dose. 27 Recent work indicating higher doses are necessary in neonates to rapidly achieve target levels. Given every 12 h.…”

Section: Age-dependent Dosingmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

298

245

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“…10,88,122 The use of this catheter reduces the number of needle sticks from 14 per week to 1 per week. 124 A recent review found that over 50% of patients who had subcutaneous catheters placed experienced minor adverse events that included induration, leakage and bruising. Only one patient, a 24-week infant, required antibiotic treatment secondary to an infected hematoma.…”

Section: Management Of Thrombosismentioning

confidence: 99%

The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed. Case study A full-term male infant born through spontaneous vaginal delivery was admitted to the neonatal intensive care unit (NICU) shortly after birth due to a history of low APGAR scores and respiratory distress requiring mechanical ventilation. The pregnancy was complicated by gestational diabetes treated with glyburide and chorioamnionitis was evident during labor. The patient was started on ampicillin and gentamicin and appropriate fluid resuscitation was initiated. The patient improved over the next few days and was able to be weaned off of ventilator support. The patient had an umbilical arterial catheter (UAC) placed after birth that was removed on day 3 of life.On day 4 of life the patient's legs appeared pale. Physical examination demonstrated cool lower extremities and markedly decreased pulses in the feet. Over the previous 24 h, urine output declined significantly.Ultrasound (US) examination of the heart, major vessels and abdomen demonstrated a large thrombus in the descending aorta with very minimal flow to the renal and iliac arteries. A literature search did not reveal any level I management guidelines for thrombosis in neonatal patients, and consideration is now given to surgical thrombectomy, anticoagulation therapy or fibrinolytic therapy. Incidence of neonatal thromboembolic diseaseAlthough neonates have the highest risk of thromboembolism (TE) in the pediatric population, the incidence of postnatal TE varies due to the types of thromboses that were reported and how aggressively centers screened for thromboses. 1 Data from the three international registries are displayed in Table 1. All three registries observed that thromboses occurred in both term and preterm infants and affected male and female infants equally, other than renal vein thrombosis (RVT) that affected more male neonates. [2][3][4] These registries also demonstrated that approximately 90% of venous thromboses in neonates were associated with central venous catheters (CVLs). [2][3][4] The recurrence rate of TE following symptomatic neonatal events ranges from 3.3 to 7%. 5 The international registries are the first step toward...

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Low-molecular-weight heparin in pediatric patients with thrombotic disease: A dose finding study

Cited by 253 publications

References 45 publications

Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

Enoxaparin therapy for arterial thrombosis in infants with congenital heart disease

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

The evaluation and management of postnatal thromboses

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