PB0642 - Increasing of enoxaparin doses in a series of 100 pediatric patients with venous thromboembolism: need for early monitoring

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Rubén Berrueco, PhD, MD

Head of Pediatric Hematology Department
Sant Joan de Déu Hospital, Barcelona, Spain.
Barcelona, Catalonia, Spain

Co-Author(s)

AC

Arturo Cohen-Sánchez

Student
Facultad de Medicina UVIC-UCC
Vic, Catalonia, Spain
AR

Anna Ruiz-Llobet

Pediatric Hematologist
Sant Joan de Déu Hospital
Barcelona, Catalonia, Spain
SG

Susanna Gassiot

Head of Laboratory Department
Sant Joan de Déu Hospital
Barcelona, Catalonia, Spain
ES

Edurne Sarrate

Laboratory Hematologist
Sant Joan de Déu Hospital
Barcelona, Catalonia, Spain
NC

Nuria Caballero

Laboratory Hematologist
Hospital Sant Joan de Déu
Barcelona, Catalonia, Spain
CB

Cristina Benedicto

Nurse Hemophilia Unit
Sant Joan de Déu
Barcelona, Catalonia, Spain
MS

María Solsona

Pediatric Hematologist
Sant Joan de Déu
Barcelona, Catalonia, Spain
EG

Elisa González-Forster

Pediatric Hematologist
Sant Joan de Déu Hospital
Barcelona, Catalonia, Spain
MM

Montserrat Mesegue

Pediatric Hematologist
Sant Joan de Déu Hospital
Barcelona, Catalonia, Spain

Background: Venous thromboembolism (VTE) is a rare condition in childhood, but its incidence is increasing. After diagnosis, enoxaparin is one of the most used treatments. It has been described that the final dose to achieve a therapeutic level of activated anti factor X (anti-Xa) is higher than in adults.

Aims: To evaluate the enoxaparin dose adjustments in pediatric patients diagnosed with VTE.

Methods: Retrospective observational study in pediatric patients (0-18 years-old) treated in a single center for a VTE using enoxaparin from January 2019 to June 2023. Demographic, VTE characteristics and anticoagulant treatment data (initial/final dose, anti-Xa evaluations, time to achieve final doses) were recorded.

Results: A total of 100 patients were included. Mean age: 5,5 +/- 5,7 years, boys 60%. Ninety percent of the cases were secondary ETV. Most frequent etiologies were central venous catheter (56%), infection (20%), cardiopathy (5%) and cancer (5%) (table 1).
Enoxaparin treatment was initiated following recommended doses from international guidelines. Anti-Xa monitoring led to a statistically significant increment of the doses (table 2). Median number of doses modifications were 0 [interquartile range 0-1]; median days to reach final dose: 3 days [range 0-9]. Of note, a total of seven patients > 1 year with asymptomatic catheter venous related VTE received treatment with a mean dose of 1.53 mg/kg every 24 hours. None of them needed dose modifications.
Dose increments were related to age (74.2% in < 1 year versus 39.6% in >1 year; p< 0.0001). No differences were found in relation with underlying cardiopathy, or other characteristics.

Conclusion(s): Almost 50% of the patients in this series needed enoxaparin dose adjustments to reach an antithrombotic level of anti-Xa. This finding was more relevant in chidren < 1 year. An early treatment monitoring allowed reaching an optimal level of enoxaparin dose in a median time of 3-4 days.