Sobredosis accidental de enoxaparina en un recién nacido

Abstract

Presentación de casos clínicos RESUMEN La enoxaparina es una heparina de bajo peso molecular utilizada en el período neonatal. Requiere menor monitoreo que la heparina estándar o no fraccionada, si bien es escaso el conocimiento actual acerca de su dosis y de los niveles terapéuticos en los neonatos. Además, existe una información muy limitada respecto del manejo de su sobredosificación en este grupo de edad. Se presenta el primer caso publicado en castellano de un neonato que recibió una dosis de enoxaparina diez veces superior a la terapéutica de forma accidental y en el que se administró una dosis aislada de protamina para revertir su efecto. Palabras clave: enoxaparina, errores de medicación, protaminas, recién nacido.

Thromboembolic complications in newborns – diagnostic value of D-dimers concentration and proposed outline of enoxaparin use

“…Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the absence of any TECs risk factor, but with any clinical symptom suggesting thrombosis, is an indication to extend the diagnosis by additional laboratory and imaging diagnostics [39,43,45,54]. Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the absence of any TECs risk factor, but in the presence of any clinical symptom suggesting thrombosis and in the absence of evidence of thrombosis in imaging diagnostics, indicates no need for pharmacotherapy and pharmacoprophylaxis and requires seeking another cause of symptoms [39,43,45,55]. Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the absence of any risk factor for TECs, but with any clinical symptom suggesting thrombosis and the presence of signs of thrombosis in imaging diagnostics, indicates the need for the EX treatment dose [55].…”

“…Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the absence of any TECs risk factor, but in the presence of any clinical symptom suggesting thrombosis and in the absence of evidence of thrombosis in imaging diagnostics, indicates no need for pharmacotherapy and pharmacoprophylaxis and requires seeking another cause of symptoms [39,43,45,55]. Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the absence of any risk factor for TECs, but with any clinical symptom suggesting thrombosis and the presence of signs of thrombosis in imaging diagnostics, indicates the need for the EX treatment dose [55]. The therapeutic dose should be continued until the signs of thrombosis have fully resolved in imaging diagnostics, howee, not less than 14 days.…”

“…Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the presence of any TECs risk factor requires extended imaging diagnostics in the newborn for TECs, regardless of the presence or absence of clinical symptoms suggesting thrombosis [39,43,45,55]. Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the presence of any TECs risk factor and no evidence of thrombosis in imaging diagnostics, indicates the need for a prophylactic dose of EX, regardless of the presence or absence of clinical symptoms [55].…”

“…Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the presence of any TECs risk factor requires extended imaging diagnostics in the newborn for TECs, regardless of the presence or absence of clinical symptoms suggesting thrombosis [39,43,45,55]. Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the presence of any TECs risk factor and no evidence of thrombosis in imaging diagnostics, indicates the need for a prophylactic dose of EX, regardless of the presence or absence of clinical symptoms [55]. The prophylactic dose should be used until the TECs risk factors disappear and/or the plasma D-dimers concentration drops to <500 ng/ml, regardless of the persistence of TECs risk factors, and in the case of persistent clinical symptoms, another cause of symptoms should be sough for [39,[56][57][58].…”

“…Plasma D-dimers concentration of 500 ng/ml -4,000 ng/ml in the presence of any TECs risk factor and in the presence of signs of thrombosis in imaging diagnostics indicates the need for a therapeutic dose of EX, regardless of the presence or absence of clinical symptoms [55,58]. The therapeutic dose should be continued until the signs of thrombosis have fully resolved in imaging diagnostics, however, not less than 14 days.…”