Dataset Information

A Critical Evaluation of Enoxaparin Dose Adjustment Guidelines in Children.

ABSTRACT:

Objectives

The purposes of this study are to perform a large-scale evaluation of the standardized dosage adjustment nomogram recommended by the American College of Chest Physicians (CHEST) for the management of enoxaparin in hospitalized pediatric patients and to determine the necessity of routine and repeated anti-factor Xa (anti-Xa) levels.

Methods

A retrospective cohort study was designed, and charts were reviewed in a single tertiary care institution for all patients who received enoxaparin between October 1, 2010, through September 30, 2016. Patients were included if they were receiving treatment doses of enoxaparin according to the pediatric CHEST guidelines, had a subtherapeutic or supratherapeutic anti-Xa level drawn at 3.5 to 6 hours after a dose, had a dose changed in an attempt to attain a therapeutic anti-Xa level, and had a second anti-Xa level drawn 3.5 to 6 hours after the dose change. Descriptive statistical methods were used to characterize the ability of dose adjustment via a nomogram to attain an anti-Xa of 0.5 to 1 unit/mL.

Results

A total of 467 patients were identified who received the appropriate initial dose and dosage adjustment and whose levels were drawn according to the CHEST guidelines. In patients who had an initial anti-Xa level of <0.35 units/mL and received the nomogram recommended dose increase of 25% ± 5%, 28 out of 96 patients (29.2%) reached therapeutic levels. Of 197 patients who had an initial anti-Xa level between 0.35 and 0.49 units/mL and who received the nomogram recommended dose increase of 10% ± 5%, 116 (58.9%) reached therapeutic levels. Of 50 patients with an initial anti-Xa level between 1.1 and 1.5 units/mL and who received the nomogram dose decrease of 20% ± 5%, 31 (62%) reached therapeutic levels.

Conclusions

The current dosage adjustment nomogram recommended by the CHEST guidelines does not reliably lead to therapeutic anti-Xa levels when used to adjust enoxaparin doses in pediatric patients.

SUBMITTER: Dinh CN

PROVIDER: S-EPMC6478360 | biostudies-literature | 2019 Mar-Apr

REPOSITORIES: biostudies-literature

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Publications

A Critical Evaluation of Enoxaparin Dose Adjustment Guidelines in Children.

Dinh Christine Nguyen CN Moffett Brady S BS Galati Marianne M Lee-Kim YoungNa Y Yee Donald L DL Mahoney Donald D

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG 20190301 2

<h4>Objectives</h4>The purposes of this study are to perform a large-scale evaluation of the standardized dosage adjustment nomogram recommended by the American College of Chest Physicians (CHEST) for the management of enoxaparin in hospitalized pediatric patients and to determine the necessity of routine and repeated anti-factor Xa (anti-Xa) levels.<h4>Methods</h4>A retrospective cohort study was designed, and charts were reviewed in a single tertiary care institution for all patients who recei ...[more]

PMID: 31019405

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Dataset Information

A Critical Evaluation of Enoxaparin Dose Adjustment Guidelines in Children.

Objectives

Methods

Results

Conclusions

Publications

A Critical Evaluation of Enoxaparin Dose Adjustment Guidelines in Children.

Similar Datasets

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