Novel uses of insulin syringes to reduce dosing errors: A retrospective chart review of enoxaparin whole milligram dosing

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

“…In our cohort, there were 19 premature neonates (o 36 weeks), the youngest being 23 weeks gestational age, weighing 530 grams, who was treated without an increased occurrence of bleeding or supra-therapeutic levels compared to term neonates. One of 40 patients (2.5%) in our cohort attained a supratherapeutic anti-Xa level after the loading phase, whereas Bauman et al 10 reported o 1% (5/514) risk of achieving supratherapeutic anti-Xa levels during the same phase. However, it is difficult to compare the two study populations.…”

“…The sample size in this study was smaller as we only evaluated outcomes in neonates. Bauman et al 10 did not report what proportion of the five patients with supratherapeutic levels were newborn infants. The same authors also used dosing regimens and adjusted the amount of enoxaparin based on CHEST (The American College of Chest Physicians) guidelines, which recommend an initial enoxaparin dose of 1.5 mg kg − 1 in neonates.…”

“…Bauman et al 10 were first to publish their experience of using enoxaparin whole milligram dosing in 514 infants and children. The cohort included 138 patients o 3 months of age (weight range: 900 to 4700 g), but the authors do not specify the percentage of premature or term neonates enrolled in the study.…”

“…11 Since 2008, all neonates and children with thrombosis requiring enoxaparin at our center have been administered whole milligram doses. Bauman et al 10 reported excellent safety and efficacy using a similar approach in 514 infants and children. There were 138 patients o 3 months of age; however, the number of neonatal patients (o 1 month) was not specified.…”

“…As the stock concentration of enoxaparin is 100 mg ml − 1 , 1 mg represents 1 U on an insulin syringe. 10 Insulin syringes have a 31-gauge needle, which can reduce pain, anxiety and local bruising in neonates and children. 11 Since 2008, all neonates and children with thrombosis requiring enoxaparin at our center have been administered whole milligram doses.…”